HomeMy WebLinkAboutState of Hawaii, Department of Health - Healthy Hawaii Strategic Plan 2023Healthy Hawai‘i
Strategic Plan 2030
Acknowledgement of Partners
Thank you to the many partners and community
stakeholders across the state of Hawai‘i who
devoted their time and effort to the creation of
the Healthy Hawai‘i Strategic Plan 2030. Please
reference the “Partners” section for additional
information about the diverse and hardworking
individuals and organizations involved.
2
Mōhala i ka wai ka maka o ka pua
Unfolded by the water are the faces of flowers.
Flowers thrive where there is water, as thriving people
are found where living conditions are good.
‘ŌLELO NO‘EAU # 2178
3
The HHSP can also be accessed, downloaded, and interacted with at the following website: www.HHSP.hawaii.gov
Aloha kākou,
The Healthy Hawai‘i Strategic Plan 2030 (HHSP) provides a roadmap for
preventing and reducing the burden of chronic disease in our state. The
HHSP is both timely and vital due to the ongoing impact of the COVID-19
pandemic on our country, state, and the people of Hawai‘i. The HHSP provides a
comprehensive pathway forward to ensure that all residents of Hawai‘i can live
healthier lives without complications from chronic disease. The disproportionate
impact of COVID-19 on some of our communities in Hawai‘i amplifies the
urgency for systemic approaches to reduce new cases of chronic disease and to
normalize managing existing conditions.
The HHSP is a guide to enable coordination across common risk factors,
interventions, and strategies. A large and diverse group of stakeholders
contributed their expertise covering asthma, cancer, diabetes, heart disease and
stroke, physical activity and nutrition, and tobacco programs. The HHSP was
developed during historic times, while stakeholders adjusted organizationally
and personally to teleworking and COVID-19 safety measures. The contributors
are from communities across the state, from public, private, non-profit, and
volunteer organizations, and through the pandemic they remained engaged in
planning for the future.
The pandemic revealed areas of susceptibility in our current health system
infrastructure and achieving health equity must continue to be part of our
recovery and ongoing endeavors. What would a future look like where the
healthy choice is the easy choice for all people in Hawai‘i? The plan identifies
priority objectives in four sector areas—Community Design and Access,
Education, Health Care, and Worksite. Working on health priorities in these
sector areas will create sustainable changes where people live, learn, work,
and play, so healthy options become the default. This is a living document, and
I welcome our partners—present and future—to work together to achieve the
“Healthy Hawai‘i Vision 2030.”
Sincerely,
Elizabeth A. Char, M.D.
Director,
Hawai‘i State Department of Health
Healthy People,
Healthy Communities,
Healthy Hawai‘i
4
5
Message from the Director .........................................................................................3
Introduction ...................................................................................................................6
Vision, Mission, and Goals ..........................................................................................7
Healthy Hawai‘i Vision 2030 .......................................................................................8
About the Healthy Hawai‘i Strategic Plan 2030 ......................................................9
Purpose of Plan ......................................................................................................9
Plan Framework .....................................................................................................9
Social Ecological Model ...............................................................................10
Policy, Systems and Environmental Change ..............................................10
Cross-Cutting Themes ..................................................................................11
Sector Areas ..................................................................................................12
Program Areas ...............................................................................................13
Objectives and Strategies .........................................................................................14
Community Design and Access Sector Objectives .........................................15
Education Sector Objectives ..............................................................................22
Health Care Sector Objectives ..........................................................................26
Worksite Sector Objectives ................................................................................32
Background .................................................................................................................35
Priority Populations .............................................................................................36
Achieving Health Equity......................................................................................37
Asthma ..................................................................................................................38
Cancer ..................................................................................................................40
Diabetes ................................................................................................................42
Heart Disease and Stroke ..................................................................................44
Physical Activity and Nutrition ..........................................................................46
Tobacco .................................................................................................................50
How the Plan was Developed ...................................................................................52
Implementation ...........................................................................................................53
Long-term Measures ..................................................................................................53
Partners ........................................................................................................................58
List of Acronyms .........................................................................................................60
References ..................................................................................................................61
Table of Contents
Chronic conditions: high blood pressure,
high cholesterol, a heart attack,
coronary heart disease, a stroke, asthma, cancer, COPD, kidney disease, diabetes, or obesity
64%
OF ADULTS IN
HAWAI‘I HAVE
ONE OR MORE
CHRONIC
CONDITIONS
Annual Costs of Chronic
Disease in Hawai‘i
$9 BILLION
DIRECT MEDICAL COSTS
$3.2 BILLION
COSTS DUE TO LOST
EMPLOYEE PRODUCTIVITY
AVERAGE PER YEAR 2016–2030
6
INTRODUCTION
The COVID-19 pandemic has brought
to the forefront the importance of
chronic disease prevention and
management, and has showcased
how inequities impact not only
the health of individuals, but of
our communities.
The COVID-19 pandemic underscores the need
for investing in chronic disease prevention, and
innovative policy, systems, and environmental change
that will impact health and health equity in Hawai‘i.
People of any age with chronic diseases, underlying
medical conditions, and those who smoke are at
increased risk for severe illness from COVID-19.
A study in the Journal of the American Heart
Association, published in 2021, estimated almost
two-thirds of COVID-19 hospitalizations in the U.S. to
be attributed to obesity, diabetes, hypertension, and
heart failure.
In 2019, 64% of adults in Hawai‘i had one or more
chronic conditions.1 The annual costs of chronic
diseases in Hawai‘i are projected to be $9 billion
in direct medical costs and an additional $3.2
billion in indirect costs due to lost employee
productivity (average per year 2016-2030).2 If the
current trend continues, by 2030 the projected cost
per Hawai‘i resident would be $8,300 per year.2
Through better prevention and treatment of chronic
diseases, these projected rates can be significantly
reduced.2 Additionally, minimizing preventable
hospitalizations would improve health equity, reduce
health care costs, and prevent overwhelming the
state’s health care system during crises such as the
COVID-19 pandemic.
The HHSP represents a coordinated effort between
public, private, and community-based organizations,
subject matter experts, public health advocates,
health care professionals, educators, policy makers,
and community representatives throughout the state.
These partners worked together to develop
objectives and strategies that utilize data, best
practices, and evidence-based science. The resulting
HHSP represents a common vision and guide for
preventing and managing chronic disease, and
ensuring that the people of Hawai‘i, especially the
most at-risk populations, can lead healthy lives.
7
VISION
Healthy People, Healthy
Communities, Healthy Hawai‘i
MISSION
Shape environments, policies, and systems
to support wellness and improve the quality
and years of life for Hawai‘i’s people
GOALS
» Improve health and wellness.
» Decrease premature death and disability
from chronic disease.
» Increase quality of life years among
Hawai‘i residents.
» Reduce health disparities.
8
HEALTHY HAWAI‘I VISION 2030
The Healthy Hawai‘i Vision 2030 represents a future where every person in Hawai‘i has the
opportunity to attain their full health potential. The framework of the HHSP recognizes that
conditions in the places where people live, learn, work, and play are major contributing factors
for health risks and outcomes.
These conditions are known as social determinants of health. The HHSP addresses the social
determinants of health and achieving health equity through its focus on policy, systems, and
environmental change in the four sector areas (Community Design and Access, Education,
Health Care, and Worksite). The objectives assume there will be collective effort by partners to
change policies, build health sustaining environments, and create meaningful connectedness
across systems.
9
Plan Framework
The HHSP incorporates principles of the Social Ecological Model and is organized into four sector
areas: Community Design and Access, Education, Health Care, and Worksite. The plan prioritizes goals,
objectives, and strategies that lead to policy, systems, and environmental change. Objectives were
developed using current data, best practices, and evidence-based science, and reflect one or more
cross-cutting themes. Stakeholders utilized this common framework to develop objectives covering the
program areas of asthma, cancer, diabetes, heart disease and stroke, physical activity and nutrition,
and tobacco.
ABOUT THE HEALTHY HAWAI‘I
STRATEGIC PLAN 2030 (HHSP)
Purpose of the Plan
The HHSP provides a comprehensive approach to realize a common vision of a healthy future for the
people of Hawai‘i. The HHSP promotes the following:
• Innovative collaborations and non-traditional partnerships to improve health equity and
to reach remote, vulnerable, and underserved populations;
• Resource sharing to minimize redundancies and safeguard sustainability;
• Use of evidence-based strategies to ensure efforts are driven by data, research, and evaluation; and
• Participation and leadership to encourage individuals and organizations to identify their
areas of strength, roles and responsibilities, and possible contributions to improve the health of
Hawai‘i’s people.
ENVIRONMENTAL
Changes that are made to the
physical/built environment.
Physical (structural changes
or programs or service),
social (a positive change
in attitudes or behavior
about policies that promote
health) and economic
factors (presence of
financial disincentives or
incentives to encourage a
desired behavior).
SYSTEMS
Changes made to rules
within an organization.
Systems change and policy
change often work hand-
in-hand. Often systems
change focuses on changing
infrastructure within a
school, park, worksite, or
health setting.
POLICY
Policies at the legislative or
organizational level.
Institutionalizing new rules
or procedures as well as
passing laws, ordinances, or
resolutions are examples of
policy changes.
Social Ecological Model
Individual
Interpersonal
Organizational
Community
Society
Society
Federal, state, and local
policy, systems, and
environmental levels
Community Neighborhoods, cities, and counties
Organizational
Schools, health care systems,
businesses, government
and community-based organizations
Interpersonal
Relationships including
those with family, friends,
co-workers, support groups,
social and cultural networks
Individual Individual attitudes, beliefs,
knowledge, and behaviors
LARGEST
IMPACT
SMALLEST
IMPACT
10
» SOCIAL ECOLOGICAL MODEL
To align with national priorities and direction, the HHSP relies on the Social Ecological Model. This model
recognizes the interwoven relationship that exists between the individual and their environment. While
individuals are responsible for maintaining a healthy lifestyle, behavior can be largely determined by
the environment in which they live through social norms, attitudes, and public policies. Effective chronic
disease prevention programs should address multiple levels of the model with attention on policy,
systems, and environmental change.
» POLICY, SYSTEMS AND ENVIRONMENTAL CHANGE
Integral to the framework and design of the HHSP is the focus on policy, systems, and environmental change.
The plan’s long-term goals, objectives, and strategies were developed to align with national guidelines and
recommendations and to reflect or lead to policy, systems, or environmental change.
11
» CROSS-CUTTING THEMES
After review of evidence-based practices for chronic disease prevention, program staff and partners
identified six cross-cutting themes to recur frequently throughout the plan.
Objectives in the HHSP were developed to reflect one or more of these cross-cutting themes:
Epidemiology,
Surveillance, and
Evaluation
Epidemiology, surveillance, and evaluation should be used to
understand the effectiveness and progress in achieving a plan’s goals
and objectives. Data should be utilized to monitor progress, address
gaps in health improvements, and prioritize next steps.
Quality of Life
Quality of life can encompass many areas of life, such as psychological
well-being, social life, support system, health status and function, and
functional or career well-being.
Community Clinical
Linkages
Community clinical links help ensure that people with or at high risk of
chronic diseases have access to the resources they need to prevent
or manage these diseases. Improved links between the community
and clinical setting offer community delivery of proven programs that
clinicians can refer patients to.
Health Equity
Health disparities exist when there is a major difference in a health
outcome between population groups. Chronic disease plans should
recognize the importance of addressing health equity and prioritize
population groups more likely to experience poor health outcomes.
Public Education and
Communications
Public education and communications can be used as strategic tools
to influence people, places, and environmental conditions. Public
education and communications can be prioritized to advance the
goals and objectives of each chronic disease plan.
Coordination
A coordinated approach and common vision are essential to
achieving the goals and objectives of this framework. Cross-coalition
collaboration, greater information sharing, and the leveraging of
resources will provide a more effective approach to implementing
the policy, systems, and environmental change necessary to support
healthy lifestyles and reduce premature death due to chronic disease.
SECTOR AREAS
Places (both physical & virtual) where policy,
systems, and environmental change can be established to
support the formation and maintenance of healthy behaviors,
achieving health equity, and maximizing chronic disease
prevention, management, and treatment.
COMMUNITY DESIGN & ACCESS
Public spaces (parks, community
centers, and places of worship),
physical infrastructure
(sidewalks and bike lanes),
and retail locations
WORKSITE
Public and private work
environments
EDUCATION
Public and private childcare
and aftercare facilities,
pre-kindergarten through
12th grade schools,
and higher education
HEALTH CARE
Public and private
health care
delivery sites
12
» SECTOR AREAS
The HHSP also utilizes a framework of four sectors: Community Design and Access, Education, Health
Care, and Worksite. This approach acknowledges the complexity of disease origins and promotes
strategies that occur in multiple settings, e.g., where people live, learn, work, and play. Policy, systems,
and environmental change in each of these settings will allow healthy options to become the easiest
choice for Hawai‘i residents.
13
Additionally, the HHSP supports and reinforces the following comprehensive, chronic disease
prevention and management strategic plans for the state:
• Hawai‘i Asthma Plan 2030
• Hawai‘i Cancer Plan 2030
• Hawai‘i Diabetes Plan 2030
• Hawai‘i Heart Disease and Stroke Plan 2030
• Hawai‘i Physical Activity and Nutrition Plan 2030
• Hawai‘i Tobacco Prevention and Control Plan 2030
» PROGRAM AREAS
The rapidly increasing prevalence of chronic disease conditions and their associated risk factors in
Hawai‘i makes the coordination of chronic disease prevention and management efforts essential.
Coordinated practice improves collaboration between stakeholders, reduces duplication, and leverages
resources to effectively address common risk factors through evidence-based policy, systems, and
environmental change. The HHSP was created to complement and align activities throughout the
following chronic disease prevention and management areas:
HHSP icon with program area icons
A STHMATOBACCO
C A NCER
D I ABETES
HEART D I S E A SE AND S
T
R
O
KE
P
HYSICAL A C T I V ITY AND N
U
T
R
ITION
14
Objectives and Strategies
The HHSP objectives strive to create sustainable change
that will transform our communities, schools, health care,
and worksites to support the health of the people of Hawai‘i.
Stakeholders developed the HHSP objectives to shape
policy, systems and environmental change in the four sector
areas: Community Design and Access; Education; Health
Care; and Worksite.
The objectives are showcased by sector area and include
key strategies, baseline, and target measures. The HHSP is
meant to be a living document that is reviewed and updated
throughout the plan’s timeframe. Implementation of the plan
will be a collective effort by individuals and organizations
across the state.
Objectives with this icon are being worked on by
multiple program areas.
* Additional background information, including definitions of some terminology used in the
objectives and strategies, can be found on the following website: www.HHSP.hawaii.gov
15
Community Design and Access
Sector Objectives
The Community Design and Access Sector includes places in the
community where people live and play, such as public spaces (parks,
community centers, and places of worship), physical infrastructure
(sidewalks and bike lanes), and retail locations.
GOAL ›› All of Hawai‘i’s people will live in communities that have access
to tobacco- and nicotine-free settings, healthy food choices, physical activity
opportunities, evidence-based chronic disease self-management programs, and
minimal exposure to unhealthy options through policy, programs, communications,
and environmental supports.
ASTHMA-01OBJECTIVE
Develop and deliver at least one promotional activity to increase awareness of asthma education
resources for non-clinical professionals.
STRATEGIES
• Identify stakeholders to establish a communications workgroup
• Convene communications workgroup regularly to develop messages tailored for targeted audience (e.g.,
coaches and/or caregivers)
• Identify media outlets that will reach targeted audience
• Disseminate messages through promotional activities (e.g., social media messages, posters, brochures, or
other printed materials) and evaluate messages
BASELINE: 0 TARGET: 1
BASELINE: 0 TARGET: 1 ASTHMA-02OBJECTIVE
Establish and sustain a funded, statewide Asthma Control Program Coordinator position to address the
burden of asthma in the State of Hawai‘i.
STRATEGIES
• Provide written support and/or meet with the Director of Health to document the need of a State Asthma
Control Program
• Provide written support/testimony to legislature to fund the Asthma Control Program Coordinator position
CO
M
M
U
N
I
T
Y
D
E
S
I
G
N
A
N
D
A
C
C
E
S
S
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
16
CANCER-01
CANCER-02
CANCER-03
OBJECTIVE
Develop at least one multi-island, small media campaign to promote Hepatitis B virus and Human
Papillomavirus (HPV) vaccinations to prevent cancer.
STRATEGIES
• Identify stakeholders such as DOH Hepatitis Program and Hawai‘i Comprehensive Cancer Coalition’s
(HCCC) Vaccine-Preventable Cancer Workgroup to establish a communications workgroup to develop a small
media campaign
• Identify and secure resources for the campaign
• Evaluate the effectiveness of the campaign
OBJECTIVE
Develop at least one multi-island, small media campaign to increase awareness about each of the
following topics: cancer as a chronic disease; the importance of family history for cancer; clinical trials;
palliative care and hospice; prostate cancer; and cancer survivorship and issues faced by
cancer survivors.
STRATEGIES
• Collaborate with cancer partners like the University of Hawai‘i Cancer Center and Kokua Mau, the Hawai‘i
Genomics Program, and the HCCC Quality of Life Action Team to establish a communications workgroup to
develop a small media campaign
• Identify and secure resources to develop the campaign
• Evaluate the effectiveness of the campaign
OBJECTIVE
Develop at least one cancer survivorship and caregiver resource guide that will include
follow-up care, lifestyle, psychosocial, and financial information.
STRATEGIES
• Establish a working group to develop the cancer survivorship resource guide in partnership with the HCCC
Quality of Life Action Team
• Evaluate the validity and value of the cancer survivors and caregivers’ resource guide
• Identify and secure resources to develop and update the guide
BASELINE: 0 TARGET: 2
BASELINE: 0 TARGET: 6
BASELINE: 0 TARGET: 1
17
CO
M
M
U
N
I
T
Y
D
E
S
I
G
N
A
N
D
A
C
C
E
S
S
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
DIABETES-01
DIABETES-02
OBJECTIVE
Establish at least one fully recognized National Diabetes Prevention Program site in the State of Hawai‘i
that provides online or distance learning.
STRATEGIES
• Support new organization(s) with the capacity to deliver the Diabetes Prevention Program (DPP) virtually or
via telehealth by facilitating and maintaining access to necessary technology
• Provide technical assistance to organizations in obtaining distance and hybrid National Diabetes Prevention
Program (NDPP) CDC recognition
• Connect referring organizations to distance learning DPP sites
OBJECTIVE
Establish at least three new American Diabetes Association recognized or Association of Diabetes Care
and Education Specialists accredited Diabetes Self-Management Education and Support sites.
STRATEGIES
• Support new organizations seeking recognition or accreditation by covering the application fees on a once-in-
a-lifetime basis and providing technical assistance
• Collaborate with American Diabetes Association, Association of Diabetes Care and Education Specialists, and
local Diabetes Self-Management Education and Support (DSMES) sites to provide training and mentoring to
new organizations
BASELINE: 0 TARGET: 1
BASELINE: 19 TARGET: 22
CANCER-04OBJECTIVE
Increase by 20%, the proportion of adults who are diagnosed with cancer and participated in a cancer-
related clinical trial.
STRATEGIES
• Address barriers to clinical trial participation and increase promotion of counter messages through outlets
such as print, broadcast, and web-based media
• Integrate clinical trials into the training curriculum of academic institutions
• Identify and implement strategies to improve efficiency and resources related to clinical trials coordination for
physicians
• Support access to clinical trials for neighbor island residents diagnosed with cancer
BASELINE: 4.80% TARGET: 5.80%
CO
M
M
U
N
I
T
Y
D
E
S
I
G
N
A
N
D
A
C
C
E
S
S
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
18
PHYSICAL ACTIVITY AND NUTRITION-01
PHYSICAL ACTIVITY AND NUTRITION-02
PHYSICAL ACTIVITY AND NUTRITION-03
OBJECTIVE
Increase by 50%, the number of food outlets that participate in a statewide healthy food
incentive program(s).
STRATEGIES
• Secure long-term funding for Hawai‘i’s Double Up Food Bucks program, which matches Supplemental Nutrition
Assistance Program (SNAP) food stamp dollars spent on Hawai‘i-grown produce
• Implement a statewide Produce Prescription Program, which enables participants to redeem “prescriptions” for
produce at participating markets and grocery stores
OBJECTIVE
Enact at least two statewide policies to increase access to healthy food and/or decrease access to
unhealthy food/beverages.
STRATEGIES
• Enact a fee on sugar-sweetened beverages, where revenue is allocated to obesity prevention initiatives
• Establish long-term, state funding for a Double Up Food Bucks SNAP incentive program
OBJECTIVE
Establish and sustain a funded Food Access Coordinator in each county to facilitate an active coalition.
STRATEGIES
• Food access coalitions will create and implement county-level action plans aimed at increasing access to, and
consumption of, healthy food
• Secure county funding to support the activities of the coordinator and food access coalition
BASELINE: 62 TARGET: 93
BASELINE: 0 TARGET: 2
BASELINE: 0 TARGET: 4
HEART DISEASE AND STROKE-01OBJECTIVE
Develop and deliver at least two promotional activities to increase awareness of the preventability of
heart disease and stroke.
STRATEGIES
• Identify stakeholders to establish a communications workgroup
• Convene communications workgroup regularly to develop messages tailored for targeted audience
• Identify media outlets that will reach targeted audience
• Disseminate messages through promotional activities (e.g., social media messages, posters, brochures, or
other printed materials) and evaluate messages
BASELINE: 0 TARGET: 2
19
CO
M
M
U
N
I
T
Y
D
E
S
I
G
N
A
N
D
A
C
C
E
S
S
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
PHYSICAL ACTIVITY AND NUTRITION-05
PHYSICAL ACTIVITY AND NUTRITION-06
OBJECTIVE
Develop guidelines to promote healthy food donations and purchase of healthy food to be adopted by
100% of Hawai‘i food banks.
STRATEGIES
• Convene a working group with representation from Hawai‘i’s foodbank network, to develop guidelines for
healthy food donations
OBJECTIVE
Increase by 50 miles, the total miles of low-stress pedestrian infrastructure including, but not limited to,
sidewalks and trails.
STRATEGIES
• Incorporate the specifications for “desirable” level of service described in the Hawai‘i Department of
Transportation’s Pedestrian Toolbox into the development of low-stress pedestrian infrastructure
• Increase Safe Routes to Schools and Safe Routes to Parks programs and projects
• Develop policies to encourage shade tree planting, to increase canopy cover, on high volume pedestrian
corridors and trails
• Increase share of state and county transportation budgets dedicated to pedestrian infrastructure
• Implement Vision Zero and Complete Streets policies to increase safety and comfort of pedestrian experience
BASELINE: 0 TARGET: 5
BASELINE: 0 TARGET: 50
PHYSICAL ACTIVITY AND NUTRITION-04OBJECTIVE
Establish and sustain a funded, statewide Breastfeeding Coordinator to facilitate efforts supportive of
breastfeeding exclusivity and duration.
STRATEGIES
• Assess statewide resources and capacity to fund and establish state-level breastfeeding coordinator position
• Develop scope and position description to include knowledge of indigenous cultures and breastfeeding
support needs
• Identify gaps and strategically integrate the breastfeeding coordinator position in a way that bridges
these gaps
BASELINE: 0 TARGET: 1
20
PHYSICAL ACTIVITY AND NUTRITION-08OBJECTIVE
The state and each county will identify and adopt mode-share goals and measurements that prioritize
walking and wheelchairs, bicycling, and transit use.
STRATEGIES
• Develop context-appropriate county-level Transportation Demand Management (TDM) Plans to establish
mode baselines
• Develop more inclusive and comprehensive metrics for measuring active transportation beyond work and
school commutes
• Support development of community Safe Routes to School (SRTS) plans, funding of SRTS infrastructure, free
transit for minors, etc
BASELINE TARGET
State 0 1
County 0 4
PHYSICAL ACTIVITY AND NUTRITION-09OBJECTIVE
Increase by 10%, the proportion of existing urbanized land zoned to support walkable communities.
STRATEGIES
• Promote Equitable Transit Oriented Development (ETOD), town centers, mixed-use development, and upzoning
for new development and zoning updates
• Adopt parking policy reforms to reduce parking oversupply, unbundle residential parking, reduce or eliminate
parking minimums, and/or shift costs
• Change Level-of-Service to Vehicle Miles Traveled (VMT) in environmental review of new development
BASELINE: Pending TARGET: Increase by 10%
PHYSICAL ACTIVITY AND NUTRITION-07OBJECTIVE
Increase by 100 miles, the total miles of low-stress bicycle infrastructure including, but not limited to,
protected bike lanes and off-street paths.
STRATEGIES
• Increase Safe Routes to Schools and Safe Routes to Parks projects
• Develop policies to encourage shade tree planting, to increase canopy cover, on high volume bicycle corridors
and trails
• Increase share of state and county transportation budgets dedicated to bicycle facilities
• Implement Vision Zero and Complete Streets policies and projects to increase safety and comfort of bicyclist
experience
BASELINE: 0 TARGET: 100
21
CO
M
M
U
N
I
T
Y
D
E
S
I
G
N
A
N
D
A
C
C
E
S
S
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
TOBACCO-01OBJECTIVE
Enact at least five more county or state policies to decrease access to all tobacco products, including
electronic smoking devices or other novel, emerging tobacco products.
STRATEGIES
• Establish regulatory parity for cigarettes, electronic smoking devices (ESDs), and emerging products, etc (e.g.
impose taxes, licensing/permitting/restricting online sales, etc)
• Prohibit the sale of all flavored tobacco products including menthol
BASELINE: 0 TARGET: 5
TOBACCO-03
TOBACCO-02
OBJECTIVE
Establish at least two more county or state policies that eliminate exposure to secondhand smoke.
STRATEGIES
• Enact a smoke-free multi-unit housing ordinance in all four major counties
• Establish policies that increase resources for smoke-free policy enforcement (at parks, beaches, public housing, etc)
OBJECTIVE
Establish at least two more statewide policies that increase access to cessation services.
STRATEGIES
• Establish a MedQUEST policy that requires health plans to offer expanded evidence-based cessation service options
• Establish a policy to formally coordinate services between the Hawai‘i Tobacco Quitline (HTQL), community
cessation providers, and a private or public insurance provider to promote access to services to consumers
• Establish a policy that requires insurance companies to expand reimbursement for youth cessation
BASELINE: 0 TARGET: 2
BASELINE: 0 TARGET: 2
22
Education
Sector Objectives
The Education Sector includes places such as public and
private childcare and aftercare facilities, pre-kindergarten through
12th grade schools, and higher education.
GOAL ›› All of Hawai‘i’s educational settings will promote tobacco-
and nicotine-free lifestyles, healthy eating, daily physical activity, and health
management through programs, policies, environmental supports, and professional
development opportunities.
ASTHMA-03OBJECTIVE
Increase by 10%, the number of sites implementing CDC-recommended school- and/or community-based
Asthma Self-Management Education programs.
STRATEGIES
• Expand the number of Asthma Self-Management Education (ASME) programs by facilitating partnerships with
school- and community-based organizations
• Promote ASME programs with the new and existing partners
BASELINE: 7 TARGET: 8
BASELINE: 13 TARGET: 14 ASTHMA-04OBJECTIVE
Increase by 10%, the number of facilitators delivering CDC-recommended school- and/or community-
based Asthma Self-Management Education.
STRATEGIES
• Expand the number of ASME programs by connecting potential volunteers
• Promote volunteer opportunities with new and existing partners
23
ED
U
C
A
T
I
O
N
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
CANCER-05OBJECTIVE
Increase by five, the number of schools that implement 1 to 2 of the recommended CDC Sun Protection
Guidelines.
STRATEGIES
• Conduct an assessment of the readiness of one or more schools to implement one or more of the
recommended CDC Sun Protection Guidelines
• Partner with cancer partners such as the Hawai‘i Skin Cancer Coalition to promote the recommended
CDC Sun Protection Guidelines
BASELINE: Pending TARGET: Increase by 5
CANCER-06OBJECTIVE
100% of eligible school-based clinics become Vaccines for Children providers.
STRATEGIES
• Conduct an assessment of eligible schools to determine their ability to become Vaccines for Children
(VFC) providers
• Partner with the HCCC’s Vaccine Preventable Cancers Workgroup to promote the importance of making
vaccines (e.g., HPV) available
BASELINE: Pending TARGET: 100%
HEART DISEASE AND STROKE-02OBJECTIVE
Adopt a wellness policy designed to provide access to blood pressure cuffs and blood pressure
education at public college campuses.
STRATEGIES
• Leverage partnerships within the University of Hawai‘i system to identify campus wellness/health
services coordinator
• Explore potential partnerships and link available resources at American Heart Association
BASELINE: 0 TARGET: 1
PHYSICAL ACTIVITY AND NUTRITION-10OBJECTIVE
Adopt at least one policy to require annual courses in Health Education and Physical Education from
grades K-8, in the Department of Education, that are aligned with national recommendations for
instructional time and teacher licensing.
STRATEGIES
• Support a Board of Education policy change to require annual courses in Health Education in grades K-8 in
Department of Education (DOE) public non-charter schools
• Support a Board of Education policy change to require annual courses in Physical Education in grades K-8 in
DOE public non-charter schools
BASELINE TARGET
Health Education courses 0 1
Physical Education courses 0 1
24
PHYSICAL ACTIVITY AND NUTRITION-12
PHYSICAL ACTIVITY AND NUTRITION-13
OBJECTIVE
50% of public non-charter schools participating in the Safety and Wellness Survey will meet at
least 90% of the wellness guidelines.
STRATEGIES
• Create a toolkit to share with all participating public schools that highlights resources for the four lowest
scoring wellness guidelines
• Create a social media campaign to educate families and community stakeholders on the DOE safety and
wellness guidelines and opportunities to support wellness in schools
• Conduct a study to evaluate qualities/characteristics/infrastructure/resources that contribute to the schools
with the lowest Safety and Wellness Survey (SAWS) score and the highest SAWS score
OBJECTIVE
Establish and sustain a funded statewide Food Systems Education Coordinator position to
support ‘āina-based education, which promotes healthy eating in preschool through grade 12 (P-12)
education settings.
STRATEGIES
• Assess statewide resources and capacity to fund and establish a statewide Food Systems Education
Coordinator position
• Develop scope and position description to include knowledge of ‘āina-based education
• Identify gaps and strategically integrate the Food Systems Education Coordinator position in a way that
bridges these gaps
BASELINE: 30% TARGET: 50%
BASELINE: 0 TARGET: 1
PHYSICAL ACTIVITY AND NUTRITION-11OBJECTIVE
Develop a system to monitor and support implementation of the Early Childhood Care and Education
Wellness Guidelines.
STRATEGIES
• Convene both public and private early learning community stakeholders to determine barriers to
implementation of Hawai‘i’s Early Childhood Care and Education (ECE) Wellness Guidelines
• Collaborate with ECE stakeholders to create a physical activity and nutrition ECE setting focused training
curricula developed from the Hawai‘i ECE Wellness Guidelines
• Partner with leaders in the early learning community to identify and implement incentives to support provider
implementation of the ECE Wellness Guidelines
BASELINE: 0 TARGET: 1
25
ED
U
C
A
T
I
O
N
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
TOBACCO-05OBJECTIVE
Develop and adopt at least one “alternative to suspension” model policy for youth vaping or tobacco
offenses in Department of Education schools.
STRATEGIES
• Develop and adopt best practice enforcement responses/guidelines for youth vaping/tobacco offenses to guide
law enforcement or Department of Education (DOE) school officials
• Pilot test a model alternative to suspension policy at a public or private school in Hawai‘i and use results to inform
expansion into other schools
BASELINE: 0 TARGET: 1
TOBACCO-07OBJECTIVE
Conduct at least ten more educational campaigns for parents or youth influencers to provide information
about tobacco/vaping prevention or cessation statewide.
STRATEGIES
• Develop culturally appropriate educational campaigns for use in school systems such as, the Hawaii Association of
Independent Schools, Charter School Commission, and Hawaii State Department of Education
• Develop education campaigns that can be used in a variety of media types (radio, television, mall ads, social media, etc)
BASELINE: 0 TARGET: 10
TOBACCO-04OBJECTIVE
All colleges and universities in the State of Hawai‘i will provide tobacco-free education and offer
cessation services to their students, staff and faculty.
STRATEGIES
• Provide tobacco prevention and cessation information at incoming student orientation sessions
• Support student health groups to conduct peer-led tobacco cessation and prevention promotion throughout all
campuses
• Create linkages between community tobacco treatment specialists, the Hawai‘i Tobacco Quitline and universities to
tailor promotions to students and increase access to cessation services for young adults
BASELINE: Pending TARGET:
All colleges and universities in Hawai‘i
TOBACCO-06OBJECTIVE
All colleges and universities in the State of Hawai‘i will have a 100% smoke-free or tobacco-free
campus policy.
STRATEGIES
• Conduct outreach to universities and colleges without tobacco-free policies to provide education and information
about the benefits of implementing a tobacco-free campus
• Provide technical support to individual private colleges and universities to encourage adoption of tobacco-free
campus policies
BASELINE: Pending TARGET:
All colleges
and universities
in Hawai‘i
26
Health Care
Sector Objectives
The Health Care Sector includes places such as public and private
health care delivery sites.
GOAL ›› All of Hawai‘i’s health care systems will promote health equity
and maximize utilization of prevention, early detection, and evidence-based chronic
disease self-management services by improving coverage, health information
technology, programs, practices, and guidelines.
MULTIPLE PROGRAM AREASOBJECTIVE
By 2025, identify six Health Information Technology priorities to enhance population health.
STRATEGIES
• Identify key Health Information Technology (HIT) stakeholders to establish a HIT workgroup
• Convene HIT workgroup regularly to identify the HIT priorities to enhance population health
ASTHMA-06 • DIABETES-03 • HEART DISEASE AND STROKE-06
BASELINE: 0 TARGET: 6
MULTIPLE PROGRAM AREASOBJECTIVE
Meet 50% of identified Health Information Technology priority goals.
STRATEGIES
• Implement priorities identified by the HIT workgroup (e.g., implement bidirectional referral systems between
health care organizations and self-management education programs or create a GIS map of chronic disease
cases to inform targeted health communication and resource utilization)
ASTHMA-07 • DIABETES-04 • HEART DISEASE AND STROKE-07
BASELINE: 0 TARGET: 50%
27
HE
A
L
T
H
C
A
R
E
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
ASTHMA-05OBJECTIVE
Establish coverage of Asthma Self-Management Education programs by Medicaid.
STRATEGIES
• Identify existing literature/guidance/cost benefit analysis on ASME coverage
• Collaborate with Medicaid and provide guidance on ASME coverage and eligibility
BASELINE: 1 TARGET: 5
OBJECTIVE
By 2025, identify five measurable outcomes indicative of team-based care and
monitor over time.
STRATEGIES
• Identify key stakeholders to establish a team-based care workgroup
• Convene team-based care workgroup regularly to identify measurable outcomes indicative of
team-based care
• Report identified outcomes at least annually
ASTHMA-08 • DIABETES-05 • HEART DISEASE AND STROKE-03
BASELINE: 0 TARGET: 5 MULTIPLE PROGRAM AREAS
OBJECTIVE
Improve identified measurable team-based care outcomes by 5%.
STRATEGIES
• Implement priorities identified by the team-based care workgroup (e.g., increase use of pharmacists in
medication management to increase physical patient panels, increase use of non-physician telehealth for
Asthma Self-Management (ASME), or increase use of Community Health Workers (CHW) in patient care
coordination)
ASTHMA-09 • DIABETES-06 • HEART DISEASE AND STROKE-04
BASELINE: Pending TARGET: Increase by 5%MULTIPLE PROGRAM AREAS
28
CANCER-09OBJECTIVE
Increase the proportion of adults receiving lung, breast, cervical, and colorectal cancer
screenings.
STRATEGIES
• Partner with the Hawai‘i Primary Care Association to increase and implement evidence-based interventions
(EBI) at FQHCs
• Identify resources and secure funding for implementation
• Evaluate the effectiveness of the implementation of the EBI
TARGET
LUNG: 9.5%
BREAST: 97.4%
CERVICAL: 92.6%
COLORECTAL: 84.1%
BASELINE
LUNG: 8.5%
BREAST: 87.0%
CERVICAL: 82.7%
COLORECTAL: 75.1%
CANCER-08OBJECTIVE
Increase by ten, the number of new community pharmacies that implement activities to increase
Hepatitis B vaccination.
STRATEGIES
• Identify pharmacies that serve communities at risk for Hepatitis B (e.g., Asian and Pacific Islander populations)
• Develop a workplan for increasing patient recruitment and reimbursement
• Identify and secure resources to implement the workplan
BASELINE: 0 TARGET: 10
CANCER-07OBJECTIVE
Increase by ten, the number of health care systems that use Health Information Technology to address
Hepatitis B vaccination.
STRATEGIES
• Identify key HIT stakeholders to establish a HIT workgroup
• Convene HIT workgroup regularly to identify the HIT priorities to enhance Hepatitis B vaccination rates
• Assess capacity of partner Federally Qualified Health Centers (FQHCs) to track and remind providers about
Hepatitis B immunization rates
• Compile best practice models to increase immunization rates using HIT at FQHCs
• Identify and secure resources to implement HIT at partner FQHCs
BASELINE: Pending TARGET: Increase by 10
29
HE
A
L
T
H
C
A
R
E
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
CANCER-11OBJECTIVE
Increase the proportion of cancer survivors who have received treatment summaries and cancer
survivorship care plans.
STRATEGIES
• Conduct an assessment of Commission on Cancer accredited cancer programs in the state on their methods of
providing treatment summaries and cancer survivorship care plans
• Develop a plan in partnership with the HCCC Quality of Life Action Team members to educate cancer survivors
on the benefits of treatment summaries and cancer survivorship care plans
• Develop a training for health care providers on ways to increase utilization of treatment summaries and cancer
survivorship care plans
TARGET
TREATMENT SUMMARIES: 49.5%
CANCER SURVIVORSHIP CARE PLANS: 33.1%
BASELINE
TREATMENT SUMMARIES: 43.8%
CANCER SURVIVORSHIP CARE PLANS: 32.1%
CANCER-10OBJECTIVE
Increase the proportion of adults who have an Advance Health Care Directive.
STRATEGIES
• Develop an educational and promotional program that emphasizes the importance of advance care planning
and having an Advance Health Care Directive
• Provide education to health professionals about the benefits of advance care planning that includes sensitivity
to culturally diverse patient needs
• Educate employers on the importance of advance care planning, especially Advance Health Care Directive
BASELINE: 36.7% TARGET: 41.1%
HEART DISEASE AND STROKE-05OBJECTIVE
Establish coverage for medication therapy management and/or self-measured blood pressure
monitoring by Medicaid.
STRATEGIES
• Identify and review existing literature/guidance on Medication Therapy Management (MTM) and
Self-Measured Blood Pressure Monitoring (SMBPM) reimbursement
• Collaborate with Medicaid and provide guidance on reimbursement for MTM and/or SMBPM
BASELINE: 0 TARGET: 1
30
PHYSICAL ACTIVITY AND NUTRITION-16OBJECTIVE
Establish comprehensive coverage for lactation consultation services and lactation supplies by all
health insurance companies in the State of Hawai‘i.
STRATEGIES
• Engage lactation consultants and other breastfeeding stakeholders to:
-Develop reimbursement models for Medicaid and commercial payers
-Pilot coverage processes
BASELINE: 0 TARGET: 6
BASELINE: 0 TARGET: 12 PHYSICAL ACTIVITY AND NUTRITION-15OBJECTIVE
Implement a Hawai‘i-specific hospital recognition program to incentivize promotion of
exclusive breastfeeding through adoption of best practices that 100% of maternity care hospitals
will participate in.
STRATEGIES
• Develop a statewide maternity care hospital recognition program, which sets policies and standards to support
exclusive breastfeeding
• Convene a Hawai‘i hospital recognition program workgroup to create, administer, and evaluate the program
PHYSICAL ACTIVITY AND NUTRITION-14OBJECTIVE
Increase by 5%, the number of people enrolled in nutrition and physical activity programs that
are offered by health system payers.
STRATEGIES
• Expand coverage for Diabetes Prevention Programs (DPPs), or evidence-based DPP-like programs (e.g., Pili
‘Ohana Department of Native Hawaiian Health)
• Work with providers, health system payers, and worksites to increase awareness of and referrals to covered
PAN programs
• Participate in Health Information Technology (HIT) workgroup to discuss potential referral options between
health care organizations and self-management education programs related to physical activity and nutrition
BASELINE: Pending TARGET: Increase by 5%
31
HE
A
L
T
H
C
A
R
E
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
TOBACCO-09OBJECTIVE
Integrate brief intervention education into at least five more health professional training programs as
a graduation requirement, and into at least two health specialty organizations (e.g. American Academy
of Pediatrics, American College of Surgeons, American Physical Therapy Association) as continuing
education offerings.
STRATEGIES
• Identify relevant “health professional training programs”—such as pharmacy, nursing, medicine, dental hygiene,
respiratory therapists, psychology, and other related allied health programs, where brief intervention education can
be incorporated
• Coordinate brief intervention trainings with the behavioral health and substance use treatment communities
BASELINE TARGET
Professional training programs Pending 5
Health specialty organizations Pending 2
TOBACCO-08OBJECTIVE
Implement at least five more health systems change policies or projects for tobacco cessation per the
Clinical Practice Guidelines and Million Hearts Tobacco Cessation Change Package.
STRATEGIES
• Integrate assessment, referral, and treatment interventions for tobacco/nicotine use in routine care in health care
systems using electronic health records
• Provide staff and clinician education about cessation services to increase referral to treatment after identifying
patients with tobacco/nicotine addiction
BASELINE: 0 TARGET: 5
32
Worksite
Sector Objectives
The Worksite Sector includes places such as public and private
work environments.
GOAL ›› All of Hawai‘i’s worksites will create a culture of wellness
through supportive programs and policies that promote tobacco-and nicotine-
free workplaces; breastfeeding; healthy food and beverage choices; physical
activity and active commuter opportunities; health screenings; and early
detection, risk reduction, and self-management of chronic diseases.
OBJECTIVE
Implement a statewide, comprehensive worksite wellness recognition program that at least
10 very small-, 15 small-, 10 medium-, and 5 large-employers will participate in.
STRATEGIES
• Identify stakeholders and convene an advisory group to develop a Hawai‘i-specific, evidence-based worksite
wellness recognition program that includes the following areas:
• Asthma • Heart Disease and Stroke
• Cancer • Physical Activity and Nutrition
• Diabetes • Tobacco
• Pilot the recognition program with a group of diverse employers and modify the program based on their
feedback.
ASTHMA-11 • CANCER-13 • DIABETES-07 • HEART DISEASE AND STROKE-09
PHYSICAL ACTIVITY AND NUTRITION-19 • TOBACCO-12
BASELINE:
very small = 0
small = 0
medium = 0
large = 0
TARGET:
very small = 10
small = 15
medium = 10
large = 5
MULTIPLE PROGRAM AREAS
33
WO
R
K
S
I
T
E
S
E
C
T
O
R
O
B
J
E
C
T
I
V
E
S
ASTHMA-10OBJECTIVE
Establish at least one statewide policy designed to increase access to evidence-based chronic disease
prevention and management programs that address asthma at worksites.
STRATEGIES
• In collaboration with Objective Asthma-11, identify stakeholders to establish an advisory group to
develop a Hawai‘i-specific worksite wellness recognition program
• Convene workgroup regularly to draft a policy
BASELINE: 0 TARGET: 1
CANCER-12OBJECTIVE
Increase by five, the number of employer groups that adopt a policy that allows time off for cancer
screenings.
STRATEGIES
• Assess the employer groups ability to establish a policy that allows time off for cancer screenings
• Partner with selected employer groups to develop a policy
• Implement the policy and evaluate the effectiveness of the policy
BASELINE: Pending TARGET: Increase by 5
HEART DISEASE AND STROKE-08OBJECTIVE
Establish at least one statewide policy designed to increase access to evidence-based chronic disease
prevention and management programs that address heart disease and stroke at worksites.
STRATEGIES
• In collaboration with Objective Heart Disease and Stroke-09, identify stakeholders to establish an advisory
group to develop a Hawai‘i-specific worksite wellness recognition program
• Convene workgroup regularly to draft a policy
BASELINE: 0 TARGET: 1
PHYSICAL ACTIVITY AND NUTRITION-17BASELINE: 0 TARGET: 2OBJECTIVE
Establish at least two statewide policies designed to increase physical activity and/or healthy food
options in government worksites.
STRATEGIES
• Establish a comprehensive worksite physical activity policy
• Establish a policy that requires nutrition standards for worksite vending machines and for meetings/events
where food is served
34
TOBACCO-11OBJECTIVE
At least fifteen more worksites in the State of Hawai‘i will have 100% tobacco-free policies.
STRATEGIES
• Develop and define criteria for 100% tobacco-free worksite campuses
• Develop tobacco-free campus policies for state and county departments
BASELINE: 0 TARGET: 15
PHYSICAL ACTIVITY AND NUTRITION-18OBJECTIVE
Establish at least one statewide policy that supports breastfeeding exclusivity and duration.
STRATEGIES
• Establish a statewide Paid Family Leave policy, which will support mothers’ ability to breastfeed by providing
leave time for mothers to care for their newborns
• Encourage employers to adopt an Infant at Work policy, which allows employees the option of bringing their
infants into the workplace and can support exclusive breastfeeding
• Encourage employers to adopt a Work from Home policy, which provides telecommuting options for
breastfeeding mothers
BASELINE: 0 TARGET: 1
TOBACCO-10OBJECTIVE
At least five more large employers (including the State and Counties) will offer health plans that promote
tobacco treatment coverage per U.S. Preventive Task Force recommendations.
STRATEGIES
• Engage unions to make changes to provide cessation coverage with no co-pay in insurance plans
• Facilitate employers’ capacity to offer programs or insurance plans that incentivize cessation or offers cessation
services with no co-pay
BASELINE: 0 TARGET: 5
Adults with Chronic Diseases, Hawaii
Chronic Diseases: Adults with Chronic Diseases, Hawaii
Asthma
16%
Diabetes
12%
Obesity
25%
High Blood Cholesterol32%
High Blood Pressure34%
Cancer
9%
Adults with Chronic Diseases, Hawaii
Chronic Diseases: Adults with Chronic Diseases, Hawaii
Asthma
16%
Diabetes
12%
Obesity
25%
High Blood
Cholesterol32%
High Blood
Pressure34%
Cancer
9%
Adults with Chronic Diseases, Hawai‘i
Hawai‘i Behavioral Risk Factor Surveillance System, 2017, 2018 Hawai‘i Behavioral Risk Factor Surveillance System, 2015, 2017, 2018
Risk Factors for Chronic Diseases
Adults Not Meeting the Physical Activity Recommendations75%
Adults Eating Less Than 5 Fruits and
Vegetables a Day
80%Adults
Smoking
Cigarettes
13%
35
In Hawai‘i, chronic diseases are among the most
prevalent, costly, and preventable of all health
problems. The past two decades have seen
unprecedented increases in chronic disease
and obesity due to pronounced changes in the
environment, behavior, and lifestyle. Sixty-four percent
of adults are living with at least one chronic condition
such as diabetes or heart disease.1 Chronic diseases
account for the top three leading causes of death.3
Obesity also continues to rise at an epidemic rate.
In just two decades, the percentage of adults with
obesity in Hawai‘i more than doubled from just over
10% in 1995 to 25% in 2018.4 Over half (59%) of adults
exceed healthy Body Mass Index (BMI) standards and
are either overweight or obese.4 Significant disparities
in overweight and obesity rates are evident in many
subpopulations, particularly across race and ethnicity.
The current obesity epidemic is the culmination of
drivers in the environment that discourage energy
expenditure while encouraging overconsumption.5
Obesity and chronic diseases are also prevalent in
Hawai‘i’s youth.6 Obesity and overweight rates in
younger populations have risen with nearly a third
(28%) of high school youth exceeding healthy BMI
standards.7 Evidence shows that chronic diseases,
including those more often observed in adulthood, are
on the rise in young people, with notable disparities.2
Youth in Hawai‘i also have some of the highest
e-cigarette use rates in the nation.7 These findings
highlight the pressing need for prevention policies and
chronic disease management efforts that target youth.
Most chronic diseases can be prevented by eating
well, being physically active, avoiding tobacco, and
getting regular health screenings. Tobacco use is the
single most preventable cause of death and disease,
followed by physical inactivity and poor nutrition.8,9
These three risk factors are major contributors to the
development of chronic diseases such as asthma,
diabetes, many types of cancer, and heart disease
and stroke.10
The COVID-19 global pandemic highlights the
necessity for a comprehensive approach that supports
innovative changes in both the public health and
health care delivery systems. Adopting such an
approach would address the needs of all people,
including priority populations, by promoting efficient
coordination between public health and health care
and adapting to rapidly changing circumstances that
impact population health.
Partners across the state of Hawai‘i who developed
the HHSP are committed to preventing chronic
disease for all residents. Recent success in large-
scale public health interventions is the result of going
beyond programming to focus on policy, systems, and
environmental change approaches. The HHSP is a
strategic plan that focuses on creating higher order
environmental, policy and systems changes that make
healthy behaviors the “default” choice.
BACKGROUND
36
Priority Populations
Hawai‘i is one of the most diverse states in the
nation. The state’s main population groups are
Native Hawaiians, Japanese, Chinese, Filipinos
and Caucasians. Hawai‘i has a larger percentage
of Native Hawaiians, Other Pacific Islanders, and
multiracial subgroups than the rest of the country.
Non-Caucasian minorities, including large immigrant
populations from Asian and Pacific Islander nations,
comprise 74% of the population.11 Although Hawai‘i
has consistently placed a high value on providing
accessible, top quality health care for all, health
disparities between population groups exist.
Numerous social, economic, and environmental
factors influence the health of individuals and
populations. For example, people with a quality
education, stable employment, safe homes
and neighborhoods, and access to high-quality,
preventive health services tend to be healthier
throughout their lives and live longer. Conversely,
people with behavioral health disorders, those
identifying as a sexual and gender minority
including lesbian, gay, bisexual, transgender, queer
and/or questioning (LGBTQ), or persons of low
socioeconomic status, often face inequitable health
outcomes. Where you live directly affects your
health in a number of ways, from the accessibility of
healthy food, to the availability of green space to be
physically active, to access to primary health care.12
In Hawai‘i, life expectancy ranges by zip code from
73 years to 87 years, a 14 year difference.12 Inequity
is also found across ethnic and non-English speaking
communities. The COVID-19 pandemic and climate
change are bearing out the disparate vulnerabilities
across communities in Hawai‘i. The HHSP recognizes
and prioritizes the importance of addressing health
equity and priority population groups that are more
likely to experience poor health outcomes.
People with access to quality
education, stable employment,
safe homes and neighborhoods,
and preventive health services live
healthier, longer lives.
A “one size fits all” approach
to expanding opportunities
for improved health is like
expecting everyone to be
able to ride the same bike.
Aiming for “Equity,” rather than
“Equality,” provides a more
tailored approach to addressing
the unique needs of our most
vulnerable populations.
Advancing Health Equity
Social determinants of
health are conditions in
the places where people
live, learn, work, and play
that affect a wide range
of health and quality-of
life-risks and outcomes.
Social Determinants of Health
Social Determinants of HealthSocial Determinants of Health
NEIGHBORHOOD
AND BUILT
ENVIRONMENT SOCIAL AND
COMMUNITY
CONTEXT
EDUCATION
ACCESS AND
QUALITY
HEALTH CARE
AND QUALITY
ECONOMIC
STABILITY
• Chronic Disease Burden
• Length of Life
• Quality of Life
HEALTH OUTCOMES
ADAPTED FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION
Social Determinants of HealthSocial Determinants of Health
NEIGHBORHOOD
AND BUILT
ENVIRONMENT SOCIAL AND
COMMUNITY
CONTEXT
EDUCATION
ACCESS AND
QUALITY
HEALTH CARE
AND QUALITY
ECONOMIC
STABILITY
• Chronic Disease Burden
• Length of Life
• Quality of Life
HEALTH OUTCOMES
ADAPTED FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION
37
Achieving Health Equity
Research suggests social determinants of health may be the most important factors in health outcomes
and health equity.
To ensure that individuals and communities across the state achieve their full health potential, the
HHSP addresses social determinants of health domains such as education; health care and quality; and
neighborhood and built environments.
The plan also provides insights on population characteristics, disease data and trends, and existing
health inequities. Communities that are most vulnerable or more likely to experience disparities have
been identified and prioritized.
38
ASTHMA
Asthma affects people of all ages and often starts
during childhood. Since 1980, asthma prevalence
has steadily climbed, making asthma the most
common, chronic childhood disease both in the
U.S. and Hawai‘i.13,14 Approximately 104,400 (9%)
adults and 30,000 (10%) children in Hawai‘i currently
have asthma.15 Among youth, more boys than girls
have asthma, but this trend reverses in adulthood,
when adult women are twice as likely as their male
counterparts to report current asthma.
Over the past decade, Hawai‘i has successfully
implemented initiatives that have set the stage for
improvements in asthma control and prevention.
For example, since 2014 there has been a steady
increase throughout the state in the number of
school-based health centers and Hawai‘i Keiki
Program nurses. Both of these programs provide
support and services to students who need
assistance with chronic conditions such as asthma.
And in 2019, Hawai‘i passed legislation authorizing
a community paramedicine program that allows
paramedics to provide treatment and disease
management assistance in the homes of patients.
This type of program will help reduce emergency
room and urgent care visits related to poorly
controlled asthma or asthma attacks.
Symptoms of an asthma attack include shortness
of breath, wheezing, and chest tightness. Asthma
attacks can be triggered by allergens (such as
dust mites, pet dander, and mold), irritants (such
as secondhand smoke and vog), and respiratory
infections (such as the flu).
In the primary care setting, asthma can be diagnosed
using spirometry (a common test for measuring lung
function) and managed with medication, usually
daily inhaled corticosteroids, and tools such as
Asthma Action Plans.16 However, when asthma is
not effectively managed, patients often need to
seek treatment in emergency departments: severe
cases can result in hospitalization or even death. In
2016, $12 million was spent in Hawai‘i on emergency
department visits for adults and children with
asthma.17 The average cost per patient for asthma
hospitalizations was $18,000.17
Despite ongoing and targeted public health efforts
to reduce the burden of asthma in Hawai‘i, asthma-
related health disparities persist. According to
an analysis of 2018 BRFSS data, 15% of Native
Hawaiian adults reported having current asthma,
compared to the state average of 9%.15 People with
lower socioeconomic status and those who live in
rural regions of Hawai‘i are also signficantly more
likely to have asthma and to have their condition
under poor control.15,19 In 2018, half of adults with
current asthma lived in households with an annual
income of less than $15,000.15 The regions with the
highest prevalence in the state in 2018 were Hilo on
Hawai‘i Island (24%) and the Waianae-Nanakuli area
of Oahu (23%), both higher than the state asthma
prevalence average (16%).15
Asthma is a chronic condition that intermittently inflames
and narrows the airways in the lungs.
1 in 11 adults in Hawai‘i
currently have asthma
Asthma Triggers Dust Mites
cockroaches
petdander
respiratory
infections
mold
vogSecondhand
Smoke
Asthma Management
cockroachtraps
flu shotMedication
Asthma Educator
MattressCovers
ASTHMA
PRIORITY
POPULATIONS
» Native Hawaiians
» Youth
$12M SPENT ON EMERGENCY DEPARTMENT
VISITS FOR ASTHMA (2016)
1 in 10 children in Hawai‘i
currently have asthma
In Hawai‘i, asthma is more
prevalent among boys
than girls and adult women
compared to men
12%
8%
9%
11%
Policy allowing students to self-administer
medication at school established 2004
School Health Aide curriculum developed by
Kapiolani Community College 2014
Smoke-free vehicle laws to protect youth from
secondhand smoke passed in all four counties 2010–2018
Insurance billing for community paramedicine and non-
hospital emergency department transports authorized 2019
Asthma Program
Area Successes
39
$18,000
AVERAGE COST PER PATIENT FOR
ASTHMA HOSPITALIZATIONS (2016)
40
CANCER
From 2012-2016, the average annual mortality
rate for all cancers combined was 158 per 100,000
males and 110 per 100,000 females.20 Lung cancer
is the leading cause of death among both men and
women.20
In 2016, there were over 62,200 Hawai‘i residents
living with cancer. 20 The annual incidence rate from
2012-2016 for all cancers combined was 426 per
100,000 in males and 400 per 100,000 in females.20
Breast cancer is the most common cancer among
women, and prostate cancer is the most common
cancer among men. 20
Despite the ongoing burden of cancer in the state,
Hawai‘i has successfully implemented programs to
alleviate cancer’s impact. For example, an Adolescent
Vaccination Peer-Education Project was implemented
on Oahu and included a curriculum to raise
awareness about adolescent vaccine-preventable
diseases; the State’s Administrative Rules were
changed to require Human Papillomavirus (HPV)
vaccinations for all students entering 7th grade; and
an evidence-based program on cancer survivorship,
Cancer: Thriving and Surviving, was developed and
offered on the island of Maui.
The risk factors that contribute to cancer affect
certain population groups more than others. These
factors include poverty, poor nutrition, lower
education levels, limited access to health care,
language barriers, toxic environmental exposures,
risky health behaviors, geographic isolation, and
genetics.21 In Hawai‘i, subgroups disproportionately
affected by cancer include Native Hawaiians,
Filipinos, Samoans, Other Pacific Islanders, and
people with lower income or lower educational
attainment.22 These subgroups are more likely to
lack insurance, encounter long distances to health
services, or experience culturally inappropriate
health care.22 The HHSP and the Hawai‘i State Cancer
Plan 2030 prioritizes engagement with the most
at-risk populations to identify culturally appropriate
strategies that will address health inequities and
reduce cancer risks.
Cancer is the second leading cause of death in Hawai‘i,
and more than 2,300 die annually from the disease.3
Hawai‘i has successfully
implemented programs to
improve the quality of life
for cancer survivors.
Breast and Cervical Cancer Treatment Program
established 2001
Mandated health care coverage for colorectal
cancer screening 2010
Cancer: Thriving and Surviving Program adopted
as part of survivorship care on Maui 2017
Human papillomavirus (HPV) vaccine curriculum
developed for Oahu school 2018
Hepatitis B vaccination program developed in
community pharmacies 2019
HPV vaccine required for all students entering 7th grade 2020
CANCER
PRIORITY
POPULATIONS
» Native Hawaiians
» Filipinos
» Other Pacific Islanders
Pe
r
c
e
n
t
a
g
e
Site Specific Cancer Screening Rates
Hawai‘i Behavioral Risk Factor Surveillance System, 2018
0
20
40
60
80
100
Colorectal Mammogram Pap Test Lung
75
TARGET
TARGET TARGET
TARGET
87 83
8
There are over 62,000 adult Cancer Survivors in Hawai‘i
CANCER IS THE
SECOND LEADING
CAUSE OF DEATH
(AFTER HEART DISEASE) IN HAWAI‘I
Cancer Risk
Factors
alcohol
Human
Papillomavirus
(HPV)
family
history
Obesity
Access to careSmoking
toxic
environmental exposures
Cancer Program
Area Successes
Hepatitis B
41
42
DIABETES
According to the Centers for Disease Control and
Prevention, 80% of people with prediabetes and
20% of people with diabetes are unaware of their
conditions, suggesting that the true prevalence of
prediabetes and diabetes is much higher.24
There have been great strides to increase awareness
of prediabetes and diabetes in Hawai‘i through
promotion of the National Diabetes Prevention
Program (DPP) and Diabetes Self-Management
Education and Support services (DSMES). The
Diabetes Prevention and Control Program (DPCP)
has increased screening, testing, and referral of
people with prediabetes, increased access to lifestyle
change programs, and increased coverage of DPP.
The availability of DPPs has increased from 0 to
17 programs since 2016, with DPP now available
in all four counties. Additionally, the DPP has
become a benefit covered by Medicare, and several
health plans and employers in Hawai‘i now offer a
DPP benefit.
Significant challenges in diabetes disease
management still remain statewide. Health
Resources and Services Administration (HRSA) data
indicate that almost 35% of Federally Qualified
Health Centers’ (FQHC) diabetic patients have
uncontrolled diabetes.25 Similarly, 2016 Physician
Quality Reporting System data show that 30% of
diabetic patients show poorly managed A1c levels.
The high rates of prediabetes, diabetes, and poorly
managed conditions contributes significantly to the
state’s health care expenditures. In 2012, Hawai‘i
spent an estimated $1.1 billion in total direct medical
expenses for undiagnosed and diagnosed diabetes,
prediabetes and gestational diabetes.26 An additional
$419 million was spent on indirect costs related to
lost productivity due to diabetes.27
Diabetes affects certain race and ethnic groups in
Hawai‘i more than others. Filipino, Native Hawaiian,
and Other Pacific Islander populations have a
prevalence of diabetes two to three times higher than
Caucasians.28 Many risk factors (e.g., family history
of diabetes, age 45 and older, ethnicity) contribute
to the disproportionate burden of diabetes on
certain subgroups.29 The HHSP provides a framework
for addressing diabetes disparities and enhancing
diabetes screening and awareness through policy,
systems, and environmental change strategies.
In the 2018 Hawai‘i Behavioral Risk Factor Surveillance
System (BRFSS), 14% of adults in the state reported that
they were diagnosed with prediabetes and 12% reported
that they were diagnosed with diabetes.23
Number of Diabetes Prevention Program (DPP)
sites increased from 0 to 17 2016–2020
DPP covered by Medicare 2018
Hawai‘i Department of Health offers HI DPP,
an online DPP platform, to recognized DPP providers
across the state 2020
DIABETES
PRIORITY
POPULATIONS
» Filipinos
» Native Hawaiians
» Other Pacific Islanders
1 out of 5 people
do not know that
they have diabetes
Weight
(overweight or obese)
Physical
Inactivity
Smoking
80%
OF PEOPLE WITH
PREDIABETES DO
NOT KNOW THAT
THEY HAVE IT
Diabetes
Program Area
Successes
DIABETES RISK FACTORS
43
$1 BILLION
spent on direct healthcare
costs for diabetes
in Hawai‘i (2012)
44
HEART DISEASE AND STROKE
More than 859,000 adults in the U.S. and 4,000 in
Hawai‘i die annually from heart disease, stroke,
or other cardiovascular diseases.30, 31 The burden
of cardiovascular disease continues to grow as
the associated risk factors for the disease also
increase, such as obesity and type 2 diabetes. The
American Heart Association (AHA) predicts that
by 2035, nearly half of the U.S. population (131.2
million people) will have at least one cardiovascular
condition*.32 Self-reported BRFSS data for Hawai‘i
reports that approximately 3% of adults have
coronary heart disease; 3% have had a stroke; 32%
have high blood cholesterol; and 34% have high
blood pressure.33 Of those with high blood pressure,
25% have not taken any medications to control their
condition.34 Among the Medicare population, 56%
have high blood pressure, and 46% have high blood
cholesterol.35, 36
Cardiovascular disease places an enormous burden
on Hawai‘i’s health and the economy. There are
over 18,000 hospitalizations annually due to
cardiovascular disease, which accounts for 22%
of the state’s hospital costs.37 These costs include
money spent on services provided within the health
care system, prescription drugs, home health, and
other related services.37 Additionally, cardiovascular
conditions remain a major risk factor for serious
illness and death related to COVID-19.38
Recent changes to national standards for diagnosing
and classifying high blood pressure are likely to
assist in Hawai‘i’s fight against cardiovascular
disease. The definition of high blood pressure
was changed from 140/90 mm Hg to 130/80 mm
Hg, which will help maximize the benefits of early
diagnosis, risk reduction, drug therapy, and lifestyle
change. Hawai‘i has also successfully implemented
a community paramedicine program that allows
paramedics to assist with public health, primary
care, and prevention services, including home visits
to help patients manage high blood pressure. These
successes, along with other policy, systems and
environmental change strategies highlighted in the
HHSP, are expected to positively impact the overall
cardiovascular health of the state.
The strategies and goals of the HHSP include a focus
on addressing the disproportionate rates of heart
disease among Hawai‘i’s most at-risk groups: Native
Hawaiians, Filipinos, and Other Pacific Islanders.
These subgroups have higher rates of coronary heart
disease, angina, history of a heart attack, and heart
attack deaths than the national rate of Caucasian
persons. According to 2018 BRFSS data, Filipinos in
Hawai‘i have significantly higher rates of high blood
pressure, and Japanese have significantly higher
rates of both high blood pressure and high blood
cholesterol.4
*Cardiovascular conditions include high blood pressure,
coronary heart disease, stroke, congestive heart failure, and
atrial fibrillation.
Cardiovascular disease is the leading cause of death
nationally and in Hawai‘i.
“Million Hearts” national initiative established 2012
National hypertension guidelines updated 2017
Self-measured blood pressure management guidance
issued by American Heart Association 2019
HEART DISEASE
AND STROKE
PRIORITY
POPULATIONS
» Native Hawaiians
» Filipinos
» Other Pacific Islanders
» Medicaid Beneficiaries
Heart Disease and Stroke Risk Factors
Family History Physical
Inactivity
Poor Diet
High Blood Pressure
Diabetes
High Cholesterol
Stress
0
10
20
30
40
50
60
High Blood Pressure
34%
56%
32%
46%
High Blood Cholesterol
Hawai‘i High Blood Pressure &
High Blood Cholesterol Prevalence
Adults Medicare Population
Pe
r
c
e
n
t
a
g
e
U.S. Cardiovascular
Disease Costs
$555 Billion2016
$1.1 Trillion
2030
American Heart Association Cardiovascular Disease: A Costly
Burden for America – Projections Through 2035, 2017
Over 1/3 of Federally
Qualified Health
Center patients with
high blood pressure
do not have their
condition under control
Heart Disease and Stroke
Program Area Successes
Health Resources and
Services Administration,
Uniform Data System, 2019
45
46
PHYSICAL ACTIVITY
AND NUTRITION
Individuals who are at a healthy weight are less
likely to develop chronic diseases, experience
complications during pregnancy, or die at an earlier
age.39, 40, 41
Overweight and Obesity
During the past 20 years, there has been a dramatic
increase in obesity in the U.S., and rates remain high.
In Hawai‘i, nearly 60% of adults are overweight or
obese, with the highest rates occurring among Native
Hawaiians (75%) and Other Pacific Islanders (73%).42
Chinese and Other Asian residents have the lowest
overweight and obesity rates, followed by Japanese
and Caucasians.42 Among Hawai‘i’s teenagers,
obesity and overweight rates are lower (28%) than
adults.43 However, there are large disparities in
teen obesity rates across race and ethnicity: almost
two-thirds (65%) of Other Pacific Islander teenagers
are overweight or obese.43 The high prevalence of
these conditions has a significant impact on the
state’s economy, as Hawai‘i spends an estimated
$470 million on obesity-related medical costs
annually.44 Although high rates of overweight and
obesity have persisted, they are largely preventable
with lifestyle modifications such as exercise and
good nutrition.45
To facilitate the integration of physical activity and
healthy eating into the daily lives of all residents,
the HHSP and the Hawai‘i Physical Activity and
Nutrition Plan 2030 have prioritized policy, systems,
and environmental change strategies. In the
past, this approach has resulted in the successful
implementation of statewide initiatives such as
Choose Healthy Now, a partnership between
the State and retailers that provides residents
opportunities to eat well by highlighting healthier
food and beverage options at the point of sale.
Other successful, statewide policies and programs
have focused on youth, such as the Early Childhood
Care and Education (ECE) Wellness Guidelines, which
incorporate physical activity into daily routines and
learning experiences; and the Healthy Beverage
Default Policy (HRS § 321-30.3), which requires food
establishments that serve kid’s meals to have a
healthy option as the default beverage.
Physical inactivity and poor nutrition are the most common
behavioral risk factors associated with obesity and other
chronic diseases.
$470 million
state medical cost
attributable to obesity
60%
OF ADULTS ARE
OVERWEIGHT OR OBESE
29%28%
62%53%
KINDERGARTENERS HIGH SCHOOLERS
LOW-INCOMEKŪPUNA
Overweight or Obese
by Priority Populations*
Physical Activity
and Nutrition Program
Area Successes
Hawai‘i State Department of Education Wellness
Guidelines Fully Adopted 2011
Choose Healthy Now Expands Statewide 2018
Early Childhood Care & Education Wellness
Guidelines Established 2018
Vision Zero Policy Passed 2019
Healthy Default Beverage Policy Passed 2019
PHYSICAL
ACTIVITY AND
NUTRITION
PRIORITY
POPULATIONS
» Keiki and Youth: 0–18 years old
» Kūpuna: 65 years and older
» Low-income: gross household income at or below 185% of federal poverty level
* Pobutsky, A., Bradbury, E., Reyes-Salvail, F., & Kishaba, G. (2013). Overweight and
obesity among Hawai‘i children aged 4 to 5 years enrolled in public schools in 2007-
2008 and comparison with a similar 2002-2003 cohort. Hawai‘i journal of medicine &
public health: a journal of Asia Pacific Medicine & Public Health, 72(7), 225–236.
Hawai‘i Health Data Warehouse, Behavioral Risk Factor Surveillance System, 2018
Hawai‘i Health Data Warehouse, National Immunization Survey, 2017
47
28%
OF HIGH SCHOOL
AGED-YOUTH
ARE OVERWEIGHT
OR OBESE
Physical Activity Barriers
Limited access to public spaces
and public transportation
Lack of safe routes to walk, bike,
or wheel
Healthy Eating Barriers
Limited access to affordable,
nutritious, culturally familiar food
Lack of cooking skills and
nutrition education
Excess availability and marketing
of unhealthy food
Adults who are
physically active
can lower their risk
of premature death,
chronic disease, and
some forms of cancer.
Forming healthy eating
habits helps prevent
chronic disease.
48
Physical Activity
Regular physical activity is vital for health and well-
being. Adults who are physically active can lower
their risk of premature death, chronic disease, some
forms of cancers, and falls and their associated
injuries. For children and adolescents, physical
activity can improve bone health, cardio-respiratory
fitness and muscle strength, reduce body fat, and
help manage symptoms of depression.46
In Hawai‘i, most adults and youth fail to meet the
federal guidelines for physical activity. Only 25% of
adults, 15% of high schoolers, and 20% of middle
school students report meeting the recommended
amount of physical activity.47 Data also indicate
that physical activity levels vary by age and race
and ethnicity. Only 18% of adults 75+ years old
meet recommendations, compared to 32% of young
adults (18-24 years old).47 Similarly, only 17% of
Chinese adults are getting enough physical activity,
compared to 31% of Caucasians.47
Nutrition
Good nutrition is important for everyone and
forming healthy eating habits helps prevent chronic
diseases like obesity, type 2 diabetes, and high
blood pressure. Most Americans, however, tend
to have diets high in sugar, saturated fats, and
sodium, and do not consume the recommended
amounts of fruits and vegetables. Across Hawai‘i,
both youth and adults show low rates of fruit and
vegetable consumption. Among high schoolers,
only 14% eat the recommended amounts of fruits
and vegetables, with Japanese youth having
the lowest rate (8%).53 Additionally, only 1 in 5
adults eat enough fruit and vegetables, with only
13% of Japanese adults eating the recommended
five servings a day.47
57%
OF INFANTS EXCLUSIVELY
BREASTFED AT 3 MONTHS
Hawai‘i Health Data Warehouse,
National Immunization Survey, 2017
49
20% of adults
eat the
recommended
amount of fruits
and vegetables
14% of high
school aged-
youth eat the
recommended
amount of fruits
and vegetables
1 out of 4 adults
meet physical activity
recommendations
Fewer than
1 in 5
middle and
high school
students meet
physical activity
recommendations
50
TOBACCO PREVENTION
AND CONTROL
Approximately 14% of U.S. adults and 6% of youth
currently smoke cigarettes.48 Cigarette smoking
leads to disease and disability, and harms nearly
every organ of the body as it causes cancer, heart
disease, stroke, lung diseases, type 2 diabetes, and
chronic health conditions.49 In Hawai‘i, about 13% of
adults and 5% of youth currently smoke cigarettes.54
Smoking claims 1,400 adult lives each year and will
contribute to 21,000 premature deaths for children
and youth under 18 years old living in Hawai‘i.50
Annually, $526 million in health care costs are directly
attributed to smoking in the state.50
Hawai‘i has made great strides in tobacco control
efforts, which has resulted in lower tobacco use
rates (20% adult smokers in 1998 vs. 13% in 2018).51
In 2006, Hawai‘i was the fourteenth state to pass
comprehensive smoke-free legislation, and in 2014
smoking became illegal on all state-owned, public
housing properties. Over the last five years, Hawai‘i
became the first state to raise the legal age of sales
for tobacco from 18 to 21; electronic cigarettes
(e-cigarettes) were banned wherever smoking is
prohibited; and all four major counties implemented
ordinances that prohibited smoking and vaping in a
vehicle whenever a minor is present.
Despite past successes and an overall decrease in
tobacco use, there are subgroups and communities
in the state that show persistently higher smoking
rates. For example, the prevalence of smoking in the
Native Hawaiian population is 22%, and persons
with a diagnosed depressive disorder are at 26%.52
Approximately one in three individuals who report
heavy drinking also smoke cigarettes, and almost
22% of the LGBT community smokes.52 The smoking
rates vary across socioeconomic factors as well.
Twenty-two percent of adults with lower incomes
(<$25,000) smoke, as well as 32% of adults who are
unemployed, and 26% of adults with less than a high
school education.52
More recently, the explosion of new and novel
tobacco products, such as e-cigarettes, has
overwhelmed the community. Hawaii youth in 2019
had among the highest e-cigarette use rates in the
nation, with 31% of high school and 18% of middle
school students reporting regular use. During 2019,
high school use in rural, neighbor island counties
fared even worse, with Kauai at 36%, Maui at 36%,
and Hawaii County at 35%.54 Moving forward,
regulation of e-cigarettes, expansion of smoke-free
policies, increases in tobacco prices, and additional
youth access policies are needed, along with
culturally tailored cessation services to reach our
most vulnerable communities.
Tobacco use is the leading cause of preventable death and
disease in the U.S. and remains a public health priority.
Youth rise in e-cigarette use in recent years compared
with cigarette smoking in Hawai‘i (YRBS)
Teens (grades 9-12) who smoke cigarettes
Teens (grades 9-12) who use e-cigarettes
2005 2007 2009 2011 2013 2015 2017 2019
0
5
10
15
20
25
30
35
Hawai‘i is the first state in the nation to raise the
legal age of tobacco sales to 21 2015
E-cigarettes are prohibited wherever smoking is
not allowed 2015
Smoking and vaping are prohibited in vehicles with
minors present 2017–2018
Tobacco Program
Area Successes
Proven population-based
measures to reduce tobacco use
Tobacco price
increases
Smoke-free
policies
Hard hitting
media campaigns
Cessation
access
$526 million
healthcare costs directly
attributed to smoking
$142 million
Medicaid costs related
to smoking
$835 per
household
Residents’ state and federal
tax burden from smoking-caused
government expenditures
$387 million
Smoking-caused productivity
losses in Hawai‘i
Retrieved from Campaign for Tobacco-Free Kids,
Toll of Tobacco in Hawai‘i November 4, 2020
https://www.tobaccofreekids.org/problem/toll-
us/hawaii
Annual healthcare
costs in Hawai‘i
TOBACCO
PRIORITY
POPULATIONS
» Native Hawaiians
» Youth
» LGBT
» Low Socioeconomic Status
» Behavioral Health Conditions
51
52
UNIFIED PLANNING APPROACH
Prior to the HHSP, individual state plans outlined
objectives and strategies for each risk factor and
chronic disease. Recognizing the opportunity to
improve collaboration and better leverage resources
and efforts, leaders and stakeholders decided that
a single, coordinated plan to prevent and reduce
chronic disease would be developed and encompass
the following program areas:
» Asthma » Cancer» Diabetes» Heart Disease and Stroke» Physical Activity and Nutrition» Tobacco
Moving to a harmonized planning approach enables
coordination of multiple programs across common
risk factors, interventions, and strategies. It also
facilitates the expansion of evidence-based policies,
programs, and services, and keeps Hawai‘i in step
with national funding requirements, recommended
strategies, and best practices that combine
multiple health areas and address the spectrum of
chronic disease.
HHSP ADVISORY GROUP MEETINGS
The development of the HHSP began in May 2019
with the initial meeting of the HHSP Advisory Group.
The Advisory Group consisted of diverse stakeholders
who set the framework for the development of the
strategic plan. The approach to developing the
coordinated HHSP centered on four sector areas:
Community Design and Access, Education, Health
Care and Worksite. Utilizing these settings focuses
disease prevention, detection, and management
efforts on areas where people spend most of their
time. The Advisory Group convened periodically
during the strategic planning process to ensure that
progress aligned with the overall purpose and vision
of the plan.
STAKEHOLDER KICK-OFF MEETING
A stakeholder kick-off meeting was held in July 2019.
Participants from the various program areas were
provided an overview of the previous individual state
plans, past accomplishments, and current challenges.
The group was then tasked with envisioning the
policy, systems, and environmental change needed
in each sector that would serve as the foundation of
the HHSP.
PROGRAM AREA STAKEHOLDER MEETINGS
Equipped with the vision of a healthier Hawai‘i,
stakeholders and content experts then met within
their program areas to generate objectives and
strategies for the HHSP. Program area discussions
centered on population-based strategies and
programs that would develop local capacity and
empower infrastructures to combat health disparities.
This collaborative process brought together
representation from health care systems; academic
institutions; private and non-profit groups;
professional and community organizations; state
and county government agencies; and resulted in
the comprehensive, population-based approach of
the HHSP.
Moving to a harmonized
planning approach
enables coordination of
multiple programs
across common risk
factors, interventions,
and strategies.
HOW THE PLAN WAS DEVELOPED
53
IMPLEMENTATION
CONTINUED COORDINATION AND ACTIVE STAKEHOLDER ENGAGEMENT ARE NEEDED TO
ACHIEVE THE HHSP OBJECTIVES BY 2030.
Program area stakeholder groups continue to meet regularly to implement the plan’s objectives and strategies,
and to monitor and evaluate progress. The HHSP is meant to be a dynamic document that is assessed and
updated throughout the plan’s timeframe. Stakeholder group membership is expected to change to assure an
inclusive, community-based participatory approach to realize the plan’s goals. The plan is meant for public
dissemination and will be available online at www.HHSP.hawaii.gov.
LONG-TERM MEASURES
The long-term measures were identified to summarize and evaluate progress toward achieving the HHSP
objectives. The long-term measures will be monitored throughout the decade to collectively illustrate the
overall health and well-being of the people of Hawai‘i and demonstrate improvements. Long-term measures
will be reviewed and updated periodically as changes are made to the HHSP.
PROGRAM AREA LONG-TERM MEASURE BASELINE TARGET
Asthma Hospitalizations for
Asthma
Children under 5 years of age:
17.5 per 100,000 (HHIC, 2015)
Persons between 5-64 years of age:
5.2 per 100,000 (HHIC, 2015)
Adults 65 years of age and older: 15.5 per 100,000 (HHIC, 2015)
Children under 5 years of age:
14.9 per 100,000
Persons between 5-64 years of age:
4.4 per 100,000
Adults 65 years of age and older: 13.2 per 100,000
Asthma ED Visits for Asthma Children under 5 years of age:
98.9 per 10,000 (HHIC, 2015)
Persons between 5-64 years of age: 51.9 per 10,000 (HHIC, 2015)
Adults 65 years of age and older: 30.9 per 10,000 (HHIC, 2015)
Children under 5 years of age:
84.1 per 10,000
Persons between 5-64 years of age: 44.1 per 10,000
Adults 65 years of age and older: 26.3 per 10,000
Asthma Use of Appropriate
Medications for Asthma
82.5% (UDS, 2019)91.6%
Cancer Cancer death rate 128.5 per 100,000 (CDC National
Center for Health Statistics National
Vital Statistics System, 2017)
122.7 per 100,000
Cancer Lung cancer death rate 28.4 per 100,000 (CDC National Center
for Health Statistics National Vital
Statistics System, 2017)
25.1 per 100,000
Cancer Breast cancer
death rate
15.6 per 100,000 (CDC National Center
for Health Statistics National Vital
Statistics System, 2017)
15.3 per 100,000
54
PROGRAM AREA LONG-TERM MEASURE BASELINE TARGET
Cancer Colon cancer
death rate
11.7 per 100,000 (CDC National Center for Health Statistics National Vital Statistics System, 2017)
8.9 per 100,000
Cancer Prostate cancer
death rate
14.5 per 100,000 (CDC National Center for Health Statistics National Vital Statistics System, 2017)
12.6 per 100,000
Cancer Mammogram in
the past 2 years
(ages 50-74)
87.0% (BRFSS, 2018)97.4%
Cancer Pap test in the past
3 years (ages 21-65)
82.7% (BRFSS, 2018)92.6%
Cancer Colorectal cancer
screening (ages 50-75)
75.1% (BRFSS, 2018)84.1%
Cancer Five-year cancer
survivorship
66.7% (BRFSS, 2012)78.7%
Cancer Sunscreen use
(ages 11-18)
Middle school students: 11.5%
(YRBS, 2017)
High school students: 11.7%
(YRBS, 2017)
Middle school students: 13.0%
High school students: 13.2%
Diabetes Diabetes death rate -
multiple cause of death
60.1 per 100,000 (DOH Vital Statistics,
2018)
52.9 per 100,000
Diabetes New cases of diabetes 7.6 per 1,000 (CDC Diabetes Atlas, 2015)5.6 per 1,000
Diabetes Diabetes test in the past
3 years (ages 40-70, BMI
over 25)
65.3% (BRFSS, 2018)73.1%
Diabetes People with diagnosed
diabetes who received
formal diabetes education
56.0% (BRFSS, 2016)63.8%
Diabetes People with diabetes with
an A1c greater than 9
34.9% (UDS, 2019)31.1%
Heart Disease
and Stroke
Coronary heart disease
death rate
66.0 per 100,000 (CDC Interactive
Atlas of Heart Disease and Stroke,
2016-2018)
58.1 per 100,000
Heart Disease
and Stroke
Stroke death rate 36.0 per 100,000 (CDC Interactive
Atlas of Heart Disease and Stroke,
2016-2018)
33.4 per 100,000
55
PROGRAM AREA LONG-TERM MEASURE BASELINE TARGET
Heart Disease
and Stroke
Adults (with high blood
pressure) who report
taking medications for
high blood pressure
75.0% (BRFSS, 2017)84.8%
Heart Disease
and Stroke
Adults with hypertension
with controlled blood
pressure
63.1% (UDS, 2019)70%
Heart Disease
and Stroke
Adults at risk for
cardiovascular events
prescribed statin therapy
(age 21 years and older)
68.7% (UDS, 2019)76.3%
Physical Activity
and Nutrition
Adults who eat five or
more servings of fruits and
vegetables per day
19.8% (BRFSS, 2015)22.8%
Physical Activity
and Nutrition
Teens (high school) who
eat five or more servings
of fruits and vegetables
per day
14.2% (YRBS, 2017)16.0%
Physical Activity
and Nutrition
Adults who have a healthy
body weight (BMI 18.5 -
25.0)
37.9% (BRFSS, 2018)42.4%
Physical Activity
and Nutrition
Teens (high school) who
have a healthy body
weight (BMI 18.5 - 25.0)
71.6% (YRBS, 2017)80.9%
Physical Activity
and Nutrition
Adults who meet aerobic
PA guidelines (150 minutes
per week)
56.5% (BRFSS, 2017)63.8%
Physical Activity
and Nutrition
Adults who meet muscle
strengthening PA
guidelines (2 or more days
per week)
35.4% (BRFSS, 2017)40.0%
Physical Activity
and Nutrition
Teens (high school) who
meet aerobic PA guidelines
(60 minutes per day)
19.6% (YRBS, 2017)30.6%
Physical Activity
and Nutrition
Teens (high school) who
meet muscle strengthening
PA guidelines (3 or more
days per week)
42.4% (YRBS, 2017)56.1%
56
PROGRAM AREA LONG-TERM MEASURE BASELINE TARGET
Physical Activity
and Nutrition
Young teens (middle school) who meet aerobic PA
guidelines (60 minutes per day)
27.0% (YRBS, 2017)30.5%
Physical Activity
and Nutrition
Young teens (middle school) who meet muscle
strengthening PA guidelines (3 or more days per
week)
50.6% (YRBS, 2017)57.2%
Physical Activity
and Nutrition
Adults who self-reported their health status as
‘Good’, ‘Very Good’, or ‘Excellent.’
83.7% (BRFSS, 2018)93.7%
Physical Activity
and Nutrition
Adults who drink soda (non-diet) at least once/day 11.7% (BRFSS, 2017)10.2%
Physical Activity
and Nutrition
Teens (high school) who drink soda (non-diet) at
least once/day
11.0% (YRBS, 2017)9.6%
Physical Activity
and Nutrition
Infants who were breastfed exclusively at
6 months
30.6% (NIS, 2017)42.4%
Physical Activity
and Nutrition
Infants who were breastfed exclusively through
3 months
57.4% (NIS, 2017)64.9%
Physical Activity
and Nutrition
Infants who were ever breastfed 89.1% (NIS, 2017)94.9%
Physical Activity
and Nutrition
Infants still breastfeeding at 8 weeks 79.4% (PRAMS, 2016)90.5%
Tobacco Current cigarette use among adults in Hawai‘i 13.4% (BRFSS, 2018)5%
Tobacco Current cigarette use among Native Hawaiian
adults
22.3% (BRFSS, 2018)8.3%
Tobacco Current cigarette use among adults with low
income
22.1% (BRFSS, 2018)8.2%
Tobacco Current cigarette use among adults who are
unemployed
32.3% (BRFSS, 2018)12%
Tobacco Current cigarette use among adults with low
educational attainment (less than a HS diploma/
GED)
26.4% (BRFSS, 2018)9.8%
Tobacco Current cigarette use among adults with diagnosed
depressive disorder
25.5% (BRFSS, 2018)9.5%
Tobacco Current cigarette use among adults who reported at
least 14 poor mental health days in the last 30 days
24.9% (BRFSS, 2018)9.3%
57
PROGRAM AREA LONG-TERM MEASURE BASELINE TARGET
Tobacco Current cigarette use among adults who reported
excessive drinking
24.0% (BRFSS, 2018)9%
Tobacco Current cigarette use among adults who identify as
lesbian, gay, bisexual, or transgender
21.6% (BRFSS, 2018)8.1%
Tobacco Current cigarette use among young teens (middle
school)
3.9% (National YRBS, 2019)3.4%
Tobacco Current cigarette use among teens (high school)5.3% (National YRBS, 2019)3.4%
Tobacco Current e-cigarette use among young teens
(middle school)
17.7% (National YRBS, 2019)10.5%
Tobacco Current e-cigarette use among teens (high school)30.6% (National YRBS, 2019)10.5%
Tobacco Young teens (middle school) who never tried
smoking cigarettes
89.5% (National YRBS, 2019)99.3%
Tobacco Teens (high school) who never tried smoking cigarettes 82.2% (National YRBS, 2019)91.2%
Tobacco Young teens (middle school) who never tried e-cigarettes 69.4% (National YRBS, 2019)77%
Tobacco Teens (high school) who never tried e-cigarettes 51.7% (National YRBS, 2019)57.4%
Tobacco Adult awareness of Hawai‘i Tobacco Quitline Services 72.3% (BRFSS, 2018)81%
Tobacco Insurance plan coverage for smoking cessation 62.4% (BRFSS, 2015)71.8%
Tobacco Adults who tried to quit smoking 56.4% (BRFSS, 2018)65.7%
Tobacco Young teens (middle school) who tried to quit using
tobacco in the last year
57% (YTS, 2019)63.3%
Tobacco Teens (high school) who tried to quit using tobacco
in the last year
60% (YTS, 2019)66.6%
Tobacco Young teens (middle school) who have been
exposed to secondhand smoke (SHS) in the home
27% (YTS, 2019)24.0%
Tobacco Teens (high school) who have been exposed to
secondhand smoke in the home
30% (YTS, 2019)26.7%
Tobacco Adult who are exposed to SHS inside their living space
from somewhere else in or around their building
No baseline TBD
58
PARTNERS
The work of the HHSP is led by the Hawai‘i State Department of Health Chronic Disease Prevention
and Health Promotion Division (CDPHPD). CDPHPD promotes health and reduces the burden of chronic
disease by empowering communities, influencing social norms, and supporting and encouraging
individuals to make healthy lifestyle choices.
CDPHPD utilizes an integrative and coordinated approach to assemble and unite partner agencies
statewide to build a shared vision, implement strategies, and secure resources that will improve the
health of the people of Hawai‘i. Contributions of time, energy, resources, and expertise are provided by
the following partner agencies and organizations:
Alan Parsa The Queen’s Medical Center
Amy Asselbaye City and County of Honolulu
Brian Wu Hawai‘i Medical Service Association
Bryan Juan Hawai‘i Primary Care Association
Carl Barton Derigo Health
Catherine Pirkle University of Hawai‘i (UH)
Office of Public Health Studies
Christina Simmons YMCA of Honolulu
Cory Chun Formerly with the American
Cancer Society
Cristeta Ancog Pediatrician
Cristina Vocalan Hawai‘i Primary
Care Association
Cynthia Au American Cancer Society
Don Weisman American Heart Association
Jennifer Ryan Hawai‘i State Department
of Education
Jessica Yamauchi Hawai‘i Public Health Institute
Joseph Humphry Internal Medicine Physician
Kristen Frost Albrecht The Food Basket
Marie Williams County of Kaua‘i
Mark Garrity Urban Pacific Consulting, LLC
May Kealoha University of Hawai‘i
May Okihiro Pediatrician
May Rose Dela Cruz UH Office of
Public Health Studies
Monica Esquivel UH Dept. of Human Nutrition,
Food and Animal Sciences
Naomi Fukuda The Queen’s Medical Center
Paula Higuchi UH Cancer Center
Ron Sanderson American Lung Association
Shane Morita The Queen’s Medical Center
Sheri-Ann Daniels Papa Ola Lokahi
Tetine Sentell UH Office of Public Health Studies
Valerie Davison UHA Health Insurance
ADVISORY GROUP MEMBERS
The HHSP Advisory Group members are partners from across the state who provide input on the
vision, purpose, and development process of the plan. Thank you to these respected leaders who
offer valuable advice and expertise.
59
PROGRAM AREA PARTNERS
Thank you to the numerous individuals
and organizations who contributed to the
development of this plan. These diverse
and esteemed partners are listed in the
following comprehensive, chronic disease
strategic plans for the state.
» Hawai‘i Asthma Plan 2030
» Hawai‘i Cancer Plan 2030
» Hawai‘i Diabetes Plan 2030
» Hawai‘i Heart Disease and Stroke Plan 2030
» Hawai‘i Physical Activity and Nutrition Plan 2030
» Hawai‘i Tobacco Prevention and Control Plan 2030
PARTNERS IN COMMON
CDC’s National Center for Chronic
Disease Prevention and Health Promotion
–established to build and strengthen
state health department capacity and
expertise to effectively prevent chronic
disease and promote health
FACILITATOR
Dave Nakashima
60
AHA American Heart Association
ASME Asthma Self-Management Education
BMI Body Mass Index
BRFSS Behavioral Risk Factor Surveillance System
CDC Centers for Disease Control and Prevention
CDPHPD Chronic Disease Prevention and Health Promotion Division
CHW Community Health Worker
DOE Department of Education
DOH Department of Health
DPCP Diabetes Prevention and Control Program
DPP Diabetes Prevention Program
DSMES Diabetes Self-Management Education and Support Services
EBI Evidence-Based Intervention
ECE Early Childhood and Education
ESD Electronic Smoking Device
FQHC Federally Qualified Health Center
HCCC Hawai‘i Comprehensive Cancer Coalition
HHSP Healthy Hawai‘i Strategic Plan
HIT Health Information Technology
HMSA Hawai‘i Medical Service Association
HPCA Hawai‘i Primary Care Association
HPV Human Papillomavirus
HRSA Health Resources Services Administration
LGBTQ We acknowledge the limited representativeness of this acronym and recognize all sexual
and gender minority communities, including but not limited to lesbian women, gay men, bisexual,
transgender, and queer or questioning people.
MTM Medication Therapy Management
PAN Physical Activity and Nutrition
PSE Policy, Systems and Environmental Change
SMART Specific, Measurable, Achievable, Relevant, and Time-Bound
UH University of Hawai‘i
UHA University Health Alliance
U.S. United States
VFC Vaccines For Children
LIST OF ACRONYMS
61
REFERENCES
1 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2019).
http://hhdw.org. Accessed on February 12, 2021.
2 Partnership to Fight Chronic Disease. What is the Impact of Chronic Disease on Hawaii? https://www.fightchronicdisease.org/
sites/default/files/download/PFCD_HI_FactSheet_FINAL1.pdf. Accessed May 21, 2021.
3 Centers for Disease Control and Prevention. National Center for Health Statistics—Stats of the State of Hawai‘i.
https://www.cdc.gov/nchs/pressroom/states/hawaii/hawaii.htm. Accessed May 21, 2021.
4 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2018).
http://hhdw.org. Accessed on November 20, 2020.
5 McGuire, S. (2012). Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.
Washington, DC: The National Academies Press. Advances in Nutrition, 3(5), 708–709. https://doi.org/10.3945/an.112.002733
6 Sentell T, Choi SY, Ching L, Quensell M, Keliikoa LB, Corriveau É, et al. Prevalence of Selected Chronic Conditions Among
Children, Adolescents, and Young Adults in Acute Care Settings in Hawai‘i. Prev Chronic Dis 2020;17:190448.
DOI: https://doi.org/10.5888/pcd17.190448
7 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Youth Risk Behavior Survey Module. (2017).
http://hhdw.org. Accessed on November 20, 2020.
8 Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Economic
Costs—United States, 1995-1999. MMWR. Morbidity and Mortality Weekly Report, 51(14), 300-3. https://www.cdc.gov/mmwr/
preview/mmwrhtml/mm5114a2.htm. Accessed May 21, 2021.
9 Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual Causes of Death in the United States, 2000. JAMA,
291(10), 1238–1245. https://doi.org/10.1001/jama.291.10.1238
10 Torres, K. Y. (2010). Chronic Disease Epidemiology and Control, 3rd Edition. Preventing Chronic Disease, 8(1), Article 1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044036/
11 U.S. Census Bureau. (2020). Hawai‘i population characteristics 2019. Retrieved from
https://census.hawaii.gov/wp-content/uploads/2020/06/Hawaii-Population-Characteristics-2019.pdf
12 Holmes, J.H., Tootoo, J.L., Chosy, J.E., Bowie, A.Y., Starr, R.R. Examining Variation in Life Expectancy Estimates by ZIP Code
Tabulation Area (ZCTA) in Hawai‘i’s Four Main Counties, 2008-2012. Preventing Chronic Disease Public Health Research, Practice,
and Policy 15(E114), 1-3.
13 Centers for Disease Control and Prevention. An Investment in America’s Health. (2013). https://www.cdc.gov/asthma/pdfs/
investment_americas_health.pdf. Accessed May 21, 2021.
14 Centers for Disease Control and Prevention. Most Recent Asthma State and Territory Data. https://www.cdc.gov/asthma/
most_recent_data_states.htm. Accessed Mar 24, 2020.
15 Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2018).
http://hhdw.org. Accessed on April 3, 2020.
16 National Asthma Education and Prevention Program. (2007). Expert Panel Report 3: Guidelines for the Diagnosis and
Management of Asthma. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/sites/default/files/media/docs/
asthsumm.pdf. Accessed May 21, 2021.
17 Hawai‘i Health Information Corporation (2016).
18 Hawaii State Department of Health, Hawaii Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2016).
http://hhdw.org. Accessed on April 3, 2020.
62
19 American Lung Association. (2017). Medicaid Coverage of Asthma Self-Management Education: A Ten-State Analysis of
Services, Providers and Settings. https://www.lung.org/getmedia/f78229bf-64fd-421a-97c4-ea355f6b9314/medicaid-
coverage-of-asthma-self-management-education.pdf.pdf. Accessed October 26, 2020.
20 University of Hawaii Cancer Center. Hawai’i Cancer at a Glance 2012-2016.
https://www.uhcancercenter.org/pdf/htr/Hawaii%20Cancer%20at%20a%20Glance%202012_2016.pdf.
Accessed May 21, 2021.
21 Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2020). Understanding and addressing
social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy. CA: A
Cancer Journal for Clinicians, 70(1), 31–46. https://doi.org/10.3322/caac.21586
22 Tsark, J. U., & Braun, K. L. (2009). Eyes on the Pacific: Cancer Issues of Native Hawaiians and Pacific Islanders in Hawai’i
and the US-Associated Pacific. Journal of Cancer Education : The Official Journal of the American Association for Cancer
Education, 24(Suppl 2), S68–S69. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914228/
23 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2018).
http://hhdw.org. Accessed on April 24, 2020.
24 Centers for Disease Control and Prevention. National diabetes statistics Report 2020. https://www.cdc.gov/diabetes/pdfs/
data/statistics/national-diabetes-statistics-report.pdf-statistics-report.pdf. Accessed May 21, 2021.
25 Healthy Resources and Services Administration. Hawaii Health Center Data. https://data.hrsa.gov/tools/data-reporting/
program-data/state/HI#fn13. Accessed November 21, 2020.
26 American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. (2018). Diabetes Care, 41(5), 917–928.
https://care.diabetesjournals.org/content/41/5/917. Accessed May 21, 2021.
27 American Diabetes Association. The Burden of Diabetes in Hawaii. http://main.diabetes.org/dorg/PDFs/Advocacy/burden-
of-diabetes/hawaii.pdf. Accessed October 26, 2020.
28 Uchima O, Wu YY, Browne C, Braun KL. “Disparities in Diabetes Prevalence Among Native Hawaiians/Other Pacific Islanders
and Asians in Hawai‘i.” Prev Chronic Dis 2019;16:180-187.
29 Centers for Disease Control and Prevention. Diabetes Risk Factors. https://www.cdc.gov/diabetes/basics/risk-factors.html.
Accessed March 24, 2020.
30 Centers for Disease Control and Prevention. Heart Disease and Stroke. https://www.cdc.gov/chronicdisease/resources/
publications/factsheets/heart-disease-stroke.htm. Accessed October 7, 2020.
31 Hawai’i State Department of Health, Hawai’i Health Data Warehouse. Hawaii’s Indicator Based Information System, “Why
It’s Important”. http://ibis.hhdw.org/ibisph-view/topic/CVD.html. Accessed on May 21, 2021.
32 American Heart Association. Heart on the Hill—February 2017. https://www.heart.org/en/get-involved/advocate/heart-
on-the-hill/heart-on-the-hill-february-2017. Accessed November 21, 2020.
33 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2017).
http://hawaiihealthmatters.org. Accessed on December 15, 2020.
34 Hawaii Health Matters: Indicators: All Data. Retrieved November 21, 2020, from http://www.hawaiihealthmatters.org/
indicators/index/view?indicatorId=5681&localeId=14
35 Hawaii Health Matters: Indicators: Hyperlipidemia: Medicare Population: State: Hawaii. Retrieved November 21, 2020, from
http://www.hawaiihealthmatters.org/indicators/index/view?indicatorId=2061&localeId=14
36 Hawaii Health Matters: Indicators: Hypertension: Medicare Population: State: Hawaii. Retrieved November 21, 2020, from
http://www.hawaiihealthmatters.org/indicators/index/view?indicatorId=2063&localeId=14
37 American Heart Association (2017). Cardiovascular Disease: A Costly Burden for America Projections Through 2035.
https://www.heart.org/-/media/files/get-involved/advocacy/burden-report-consumer-report.pdf?la=en
38 Centers for Disease Control and Prevention. Covid-19—People at Increased Risk And Other People Who Need to Take Extra
Precautions. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html. Accessed February 11, 2020.
63
39 National Institutes of Health (NIH). (1998). National Heart, Lung, and Blood Institute and National Institute of Diabetes and
Digestive and Kidney Diseases. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in
adults: The evidence report. Bethesda, MD: NIH
40 World Health Organization (WHO). (1999). Obesity: Preventing and managing the global epidemic. Geneva: WHO.
41 Dietz, W. H. (1998). Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics, 101(3 Pt 2),
518–525.
42 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2018).
http://hhdw.org. Accessed on March 23, 2020.
43 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Youth Risk Behavior Survey Module. (2017). http://
hhdw.org. Accessed on March 25, 2020.
44 Trogdon, J. G., Finkelstein, E. A., Feagan, C. W., & Cohen, J. W. (2012). State- and payer-specific estimates of annual medical
expenditures attributable to obesity. Obesity (Silver Spring, Md.), 20(1), 214–220. https://doi.org/10.1038/oby.2011.169
45 Centers for Disease Control and Prevention. Overweight & Obesity—Strategies to Prevent Obesity. https://www.cdc.gov/
obesity/strategies/index.html. Accessed March 24, 2020.
46 Centers for Disease Control and Prevention. CDC Healthy Schools—Physical Activity Facts. https://www.cdc.gov/healthyschools/
physicalactivity/facts.htm. Accessed March 24, 2020.
47 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2017).
http://hhdw.org. Accessed on March 23, 2020.
48 Campaign for Tobacco-Free Kids. The Toll of Tobacco in the United States. https://www.tobaccofreekids.org/problem/toll-us.
Accessed May 21, 2021.
49 United States Surgeon General. (2014). The Health Consequences of Smoking — 50 Years of progress: A Report of the Surgeon
General: (510072014-001) [Data set]. American Psychological Association. https://doi.org/10.1037/e510072014-001
50 Campaign for Tobacco-Free Kids. The Toll of Tobacco in Hawaii. https://www.tobaccofreekids.org/problem/toll-us/hawaii.
Accessed May 21, 2021.
51 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (1997 and
2018). http://hhdw.org. Accessed on October 26, 2020.
52 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Behavioral Risk Factor Surveillance System. (2018).
http://hhdw.org. Accessed on October 26, 2020.
53 Hawai‘i State Department of Health, Hawai‘i Health Data Warehouse. Youth Risk Behavior Survey. (2017). http://hhdw.org.
Accessed on October 26, 2020.
54 Hawaii State Department of Health, Hawaii Data Warehouse: Youth Risk Behavior Survey. (2019). http://hhdw.org. Accessed
on May 21, 2021.
David Ige, Governor of Hawai‘i
Elizabeth A. Char, M.D., Director of Health
For more information contact:
Hawai‘i State Department of Health
Chronic Disease Prevention and Health Promotion Division
1250 Punchbowl St. Room 422
Honolulu, Hawai‘i 96813
PHONE: (808) 586-4488
The HHSP can be accessed, downloaded, and interacted with
at the following website: www.HHSP.hawaii.gov
Non Discrimination in Services
We provide access to our programs and activities without
regard to race, color, national origin, language, age, sex, religion, or disability.
Write or call the Chronic Disease Prevention and Health Promotion Division
or our Affirmative Action Officer at P.O. Box 3378, Honolulu Hawai‘i 96801-3378
or (808) 586-4110 (voice/TTY) within 180 days of a discrimination incident.
Date of Publication: June 2021 • Date of Printing: June 2021